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Infections of Nervous System Flashcards

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1
Q

what may untreated CNS infection cause?

A

brain herniation and death

cord compression and necrosis with subsequent permanent paralysis

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2
Q

what is bacterial meningitis?

A

infection of brain meninges

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3
Q

what are the two types of meningitis?

A

acute pyogenic (bacterial) meningitis

acute aseptic (viral) meningitis

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4
Q

what causes meningitis in neonates?

A

listeria
group B strep
E. coli

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5
Q

what causes meningitis in children?

A

H influenzae

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6
Q

what causes meningitis in ages 10-21?

A

neisseria meningitidis

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7
Q

what causes meningitis in ages >21?

A

strep pneumoniae > neisseria meningitidis

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8
Q

what causes meningitis in ages >65?

A

strep pneumoniae > listeria

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9
Q

what causes meningitis in those with decreased cell mediated immunity?

A

listeria monocytogenes

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10
Q

what causes meningitis in those with head trauma / post neurosurgery?

A

staphylococcus

gram negative bacilli

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11
Q

what causes meningitis in those with fracture of cribiform plate?

A

strep pneumoniae

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12
Q

what causes meningitis in those with CSF shunt?

A

staph epidermis
staph aureus
aerobic GNR
propionibacterium acnes

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13
Q

what is the three main ways bacterial meningitis can colonise?

A

nasopharyngeal colonisation

direct extension of bacteria (from parameningeal foci or across skull defects)

from remote foci of infection (endocarditis etc)

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14
Q

what is the pathology of bacterial meningitis?

A

thick layer of suppurative exudate which covers leptomeninges over surface of brain

also exudate in basal and convexity surface

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15
Q

what is present in subarachnoid space in bacterial meningitis?

A

neutrophils

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16
Q

what are the symptoms of bacterial meningitis?

A 
fever 
neck stiffness 
change in mental state 
headache 
rash 
papilloedema (3%)
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17
Q

what is gold standard for diagnosis of meningitis?

A

lumbar puncture - send 4 tubes away

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18
Q

in what cases would you give a CT before lumbar puncture?

A 
immunocompromised 
history of CNS disease
new onset seizure 
papilloedema (raised ICP)
altered level of consciousness 
focal neurological deficit
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19
Q

what additional investigations may you carry out in suspected bacterial meningitis?

A

blood cultures
FBC + coagulation screening
swab rash
throat swab = meningococci

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20
Q

what is given as empirical treatment before lumbar puncture in bacterial meningitis?

A

10 days of ceftriaxone IV 2g bd and dexamethasone IV 10mg

penicillin allergic = chloramphenicol IV 25mg

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21
Q

what is the treatment once meningococcus (neisseria meningitidis) confirmed?

A

ceftriaxone (5-7 days)

stop dexamethasone

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22
Q

what is given when pneumococcus confirmed?

A

ceftriaxone (10-14 days)

4 days dexamethasone

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23
Q

what is given if listeria suspected (if >60 or immunocompromised)?

A

amoxicillin IV 2g hourly
stop dexamethasone

allergic = co-trimoxazole IV 120mg

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24
Q

what is given when H influenzae confirmed?

A

10 days ceftriaxone

stop dexamethosone

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25
what do you add to treatment if patient has recently travelled to places with penicillin resistant pneumococcal?
vancomycin IV or rifampicin IV / PO
26
when would a hospital admission be required for bacterial meningitis?
signs of meningeal irritation impaired conscious level petechial rash febrile or unwell and have had a recent fit any illness (especially headache) and are close contacts of patients with meningococcal infection, even if they have received a prophylactic antibiotic
27
what measures can be taken to try and prevent secondary cases of bacterial meningitis?
telephone reporting to public health GPs informed to locate close contacts to implement chemoprophylaxis and vaccination
28
what are the 3 options which can be given as contact prophylaxis of bacterial meningitis?
rifampicin PO 12-hourly for four doses (adults and children >12 years) ciprofloxacin PO single dose for adults and children >12 years ceftriaxone IM single dose in adults, IV single dose in children under 12 years
29
what are side effects of rifampicin?
reduced efficacy of oral contraceptives red colouration of urine staining of contact lenses
30
what are the complications of bacterial meningitis?
purulence invasion cerebral oedema ventriculitis / hydrocephalus
31
where does purulence occur when it is a complication of bacterial meningitis?
clusters at base of brain convexities of rolandic and sylvian sulci exudate around cranial nerves (esp III and VI)
32
how does invasion occur when it is complication of bacterial meningitis?
pia prevents meningitis becoming abscess abscesses can cause secondary ventriculitis and hence meningitis
33
where is neisseria meningitidis usually found in healthy carriers?
throat
34
how does neisseria meningitidis probably gain access to the meninges?
blood stream
35
are the symptoms of neisseria meningitidis are usually due to exotoxin or endotoxin?
endotoxin
36
who does neisseria meningitidis most often cause disease in?
young children
37
to prevent epidemics of neisseria meningitidis in training camps, military recruits are vaccinated with what?
purified capsular polysaccharide
38
as well as meningitis, what else can meningococcal infection cause?
local - conjunctivitis, arthritis meningitis with septicaemia fulminant septicaemia
39
where is H influenzae normally found?
throat
40
what type of H influenzae is most common cause of meningitis in children under 4?
type b
41
where is strep pneumoniae commonly found?
throat
42
who is most susceptible to pneumococcal meningitis?
hospitalised patients patients with CSF skull fractures diabetics / alcoholics young children
43
there is some evidence that pneumococcal meningitis is related to CNS devices such as what?
cochlear implants
44
does the conjugate vaccine for pneumococcal pneumonia also protect against pneumococcal meningitis in children?
yes
45
who does listeria monocytogenes meningitis usually occur in?
neonates >55 immunosuppressed especially malignancy
46
what type of bacteria is listeria monocytogenes?
gram positive bacilli
47
what vaccination is available for neisseria meningitidis?
serogroups A and C (W135 and Y) commonly used in travel vaccination
48
what vaccination is available for haemophilus influenzae meningitis?
HiB vaccine
49
what vaccination is available for streptococcus pneumoniae meningitis?
pneumococcal vaccines (polysaccharide and conjugate)
50
what is more common - bacterial or viral meningitis?
viral
51
when does viral meningitis most commonly occur?
late summer / autumn
52
what causes viral meningitis?
enteroviruses eg ECHO | other microbes and non-infectious causes
53
how is viral meningitis diagnosed?
viral stool culture throat swab CSF PCR
54
how is viral meningitis treated?
supportive - self limiting
55
what is aseptic meningitis?
this is a term used to mean non-pyogenic bacterial meningitis
56
what is the characteristics of the spinal fluid in aseptic meningitis?
low WBC elevated protein normal glucose
57
what causes aseptic meningitis?
``` infection carcinomatous sarcoidosis vasculitis dural venous sinus thrombosis migraine drugs - co-trimox, IVIG, NSAIDs ```
58
what infection must you not forget is a cause of aseptic meningitis?
HSV
59
what is encephalitis?
infection of brain parenchyma
60
what are the symptoms of encephalitis?
``` insidious onset meningismus stupor, coma seizures, partial paralysis confusion, psychosis speech, memory symptoms focal or diffuse neurological signs ```
61
what is most common virus which causes encephalitis?
HSV
62
how is encephalitis diagnosed?
lumbar puncture EEG MRI
63
how do you treat encephalitis?
pre-emptive acyclovir
64
what is tuberculosis meningitis?
meningitis caused by M tuberculosis
65
who does tuberculosis meningitis usually affect?
elderly as reactivation
66
what are symptoms and investigation results in tuberculosis meningitis?
often non-specific ill health previous TB on CXR poor yield from CSF
67
what is treatment of tuberculosis meningitis?
isoniazid + rifampicin key add pyrazinamide + ethambutol
68
what is cryptococcal meningitis and who does it usually occur in?
fungal type of meningitis which usually occurs in those with HIV
69
what is the CD4+ value in cryptococcal meningitis?
<100
70
what are the symptoms of cryptococcal meningitis?
subtle neurological presentation | disseminated infection symptoms
71
what investigations should take place in cryptococcal meningitis?
CSF - aseptic serum and CSF cryptococcal antigen
72
what is treatment for cryptococcal meningitis?
IV amphotericin B + flucytosine for 2 weeks add fluconazole PO for 8 weeks

Neurology (32 decks)

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