Flashcards in CNS Infections Deck (42)
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1
Why are infections in the cranial cavity so dangerous?
Infection leads to inflammation which in an enclosed space like the skull leads to compression herniation and necrosis.
2
If you have pyogenic meningitis in a non immunosuppressed patient caused by a gram +ve what is it likely to be?
Streptococci Pneumonia
3
If you have pyogenic meningitis in a non immunosuppressed patient caused by gram -ve rods what is it likely to be?
Neisseria Meningitidis
4
If you have pyogenic meningitis in an immunosuppressed patient caused by gram +ve rods what is it likely to be?
Listeria Monocytogene
5
If you have a pyogenic meningitis in an immunosuppressed patient caused by gram -ve what is it likely to be?
H.Influenzae
6
Someone presents with pyogenic meningitis what is the treatment?
IV Ceftriaxone 2g
IV Dexamethasone
7
What organisms would IV Ceftriaxone be effective for?
Pneumococcus
Meningococcal
H.Influenzae
8
If someone is Penicillin allergic what is the alternative to Ceftriaxone?
Chloramphenicol IV 25mg
9
When is Listeria considered a suspected cause of meningitis?
Over 60's
Immunosuppressed diabetes Alcohol
10
If Listeria is the suspected cause of the meningitis what is the treatment?
IV Ceftriaxone
IV Dexamethasone
IV Amoxicillin 2g 4 hourly
11
If someone has recently travelled and presents with meningitis what is the treatment?
IV Ceftriaxone
IV Dexamethasone
IV Vancomycin - increased risk of Penicillin resistance
12
For all cases of Pyogenic Meningitis what is the baseline length of treatment ?
5 days
13
A Purpuric non blanching rash is only present in one form of meningitis. Which organism is responsible?
Meningocococcal Menigitis
14
What is the presentation of viral meningitis?
Headache Fever Neck Stiffness
15
When is a common time for people to contract Viral Meningitis ?
Late Summer Autumn
16
What are two common causes of viral meningitis ?
Enterovirus
HSV - Most severe infection
17
What is the treatment for viral meningitis?
Usually supportive due to its self limiting nature.
18
What is used to diagnose viral meningitis ?
CSF
PCR
19
What are the clinical signs of encephalitis ?
Confusion
Coma
Behavioural Changes - due to cerebral cortex involved
20
What signs can show up on MRI that might indicate a encephalitis?
Temporal lobe and adjacent parahippocampal gyrus are bright white on MRI
21
What gives the definitive diagnosis of encephalitis ?
Lumbar puncture
22
What are the clinical signs of a CNS infection?
Headache
Vomiting
Pyrexia
Neck Stiffness
Photophobia
Lethargy
Confusion
Rash
23
What nerves are at risk in a very purulent meningitis?
III Oculomotor
VI Abducens
24
What routes can an infection take to cause a meningitis ?
Direct route - Invasion through bone into the cranial cavity e.g. mastoiditis from middle ear
Remote focus - Endocarditis Myocarditis blood
25
If there is a suspicion of a raised ICP what should be undertaken before a Lumbar Puncture ?
CT
26
What region are you trying to hit in a lumbar puncture?
Sub Arachnoid Space
27
How may vials should be taken and where should they be sent to?
1 Haematology Cell Count and differentiation
2 Microbiology - Gram stain and culture
3 Chemistry - Glucose Protein
4 Haematology - Cell count
28
What is normal for a CSF sample?
Protein - 0.15 to 0.45
Glucose - 40 to 60% of blood
No RBC
WBC 5mm³
29
Bacterial Meningitis
WBC >2000mm³
Neutrophils >1180
High Protein >220
Low Glucose
30
