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Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What is meningitis?

A

Inflammation of the pia and arachnoid mater

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2
Q

What is meningism?

A

Stiffness of the neck, photophobia, severe headache

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3
Q

What are general symptoms of bacterial/viral meningitis?

A

Fever, feel unwell, rash

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4
Q

In what type of meningitis is the rash haemorrhagic?

A

Meningococcal meningitis

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5
Q

What are the main viruses that can cause meningitis?

A

Enteroviruses, HSV, Mumps, Lymphocytic choriomeningitis virus

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6
Q

What is the main bacteria that can cause meningitis in neonates?

A

E.coli

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7
Q

What are the main bacteria that can cause meningitis in infants, young adults and the elderly?

A

Neisseria meningitidis, Streptococcus pneumoniae

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8
Q

What is encephalitits?

A

Inflammation of the cerebral cortex

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9
Q

What are the symptoms of encephalitis?

A

Lethargy and fatigue, decreased level of consciousness, fever, occasionally there may be fits

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10
Q

What’s it called if a patient has encephalitis and meningism?

A

Meningo-encephalitis

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11
Q

What are the viruses that can cause encephalitis?

A

HSV, VZV, Paroviruses, HIV, Mumps, Measles

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12
Q

What does normal CSF look like?

A

Gin-clear with a pressure of <15 cm of H2O

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13
Q

What analysis can you perform on CSF?

A

Cell count, gram film, protein, glucose, culture on blood/chocolate agar, PCR

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14
Q

What blood tests can you do?

A

Blood cultures and PCR

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15
Q

What nose/throat swab tests can you do?

A

Blood/chocolate agar and PCR

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16
Q

What stool test can you do?

A

PCR

17
Q

What CSF changes are consistent with a bacterial infection?

A

Neutrophil dominant leucocytosis, raised protein, reduced CSF glucose to serum glucose ratio

18
Q

What pathogen is it if gram stain shows gram negative cocco-bacilli, chocolate agar grows small white colonies and growth only occurs around the X&V disc on nutrient agar?

A

Haemophilus influenzae

19
Q

How should you treat empirically in a 9 month old with suspected meningitis?

A

IV cefotaxime or ceftriaxone

20
Q

Why should you also give IV dexamethasone be started in some meningitis cases?

A

It reduces the risk of long term neurological complications from some bacterial causes of meningitis

21
Q

When should IV dexamethasone be started?

A

As soon as diagnosis is considered

22
Q

What bacteria is it if gram stain shows gram positive diplococci and blood agar shows alpha-haemolytic colonies that are sensitive to optochin?

A

S.pneumoniae

23
Q

What drugs should you start empirically in a 1 day old baby who’s become floppy and blue?

A

Cefotaxime and amoxicillin

24
Q

What bacteria is it if gram stain shows gram positive cocci in chains, blood agar shows beta-haemolytic colonies and latex agglutination test shows Lancefield group B?

A

Group B streptococcus

25
Q

What is the most likely source of Group B streptococcus?

A

Maternal genital tract

26
Q

What % of people who can child-bear may be asymptomatically carry Group B strep in their genital tract?

A

Up to 25%

27
Q

What is the likely pathogen if the patient is immunosuppressed, gram stain shows gram positive bacilli and blood agar shows pinpoint/small semi-transparent colonies with narrow haemolytic zone?

A

Listeria monocytogenes

28
Q

Who is at risk of meningitis from L.monocytogenes?

A

Anyone immunocompromised, pregnant women, neonates, older individuals, immunosuppressive conditions, chronic glucocorticosteroid use, DM

29
Q

How should you manage meningitis caused by L.monocytogenes?

A

IV amoxicillin at a high dose and high frequency. You can also add IV gentamicin

30
Q

What bacteria is it if the history is classic meningitis in a university student?

A

Neisseria meningitidis

31
Q

How can Neisseria meningitidis be confirmed?

A

Peripheral blood culture/molecular testing, lumbar puncture isn’t necessary

32
Q

What does N.meningitidis look like on a gram film?

A

Gram negative diplococci

33
Q

What should you do when someone is diagnosed with meningitis?

A

Inform PHE and give close contacts antibiotic prophylaxis, a single dose of oral ciprofloxacin

34
Q

What CSF changes indicate viral encephalitis or meningitis?

A

Predominantly lymphocytic response, moderately raised protein, glucose more than 50% of the level in the paired serum sample

35
Q

What should you start when HSV encephalitis is probable?

A

IV acyclovir

36
Q

What investigation should you do to confirm HSV encephalitis?

A

PCR

Neurology (22 decks)

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