Infections of the Nervous System

Question 1

What is meningitis?

Answer 1

Inflammation and infection of meninges

Question 2

What are the common symptoms of meningitis?

Answer 2

Headache 
Fever 
Neck stiffness 
Altered mental state 
Photophobia 
Nausea/ vomiting
Seizures 
Petechial skin rash

Question 3

What are the bacterial causes of meningitis?

Answer 3

Meningococcus

Pneumococcus

Question 4

What is the viral cause of meningitis?

Answer 4

Enterovirus

Question 5

What is encephalitis?

Answer 5

Inflammation and infection of brain substances

Question 6

What are the clinical symptoms of encephalitis?

Answer 6

Progressive headache 
Meningism 
Confusion 
Abnormal behaviour 
Memory disturbance 
Depressed conscious level 
Seizures

Question 7

What are the investigations for meningitis?

Answer 7

Blood cultures

Lumbar puncture

Question 8

What are the investigations for encephalitis?

Answer 8

Blood cultures
CT/MRI
Lumbar puncture
EEG

Question 9

What are the antibodies associated with auto-immune encephalitis?

Answer 9

Anti-voltage gated potassium channel

Anti-NMDA

Question 10

What are the CSF findings for bacterial meningitis?

Answer 10

Opening pressure increased
High cell count, mainly neutrophils
Glucose reduced or zero
High protein

Question 11

What are the csf findings for viral meningitis or encephalitis?

Answer 11

Opening pressure normal or increased
Cell count high, mainly lymphocytes
Glucose normal
Protein slightly increased

Question 12

What is the specific investigation for herpes simplex encephalitis?

Answer 12

Lab diagnosis by PCR of CSF for viral DNA

Question 13

What is the treatment for herpes simplex encephalitis?

Answer 13

Aciclovir

Question 14

Where is the herpes simplex virus found latent after primary infection?

Answer 14

Trigeminal and sacral ganglion

Question 15

What is the significance of arbovirus encephalitides?

Answer 15

Relevant to travel history, common in sub/tropics

Question 16

What is a brain abscess?

Answer 16

Localized area of pus within the brain

Question 17

What are the clinical features of a brain abscess or empyema?

Answer 17

Fever 
Headache 
Seizures 
Hemiparesis 
Dysphasia 
Signs of raised ICP (depressed conscious level, papilloedema)

Question 18

What are the causes of brain abscess and empyema?

Answer 18

Penetrating head injury
Spread from adjacent infection
Blood borne infection (bacterial endocarditis)

Question 19

What are the investigations for brain abscess or empyema?

Answer 19

CT/MRI
Investigate source
Blood cultures
Biopsy/ drainage of pus

Question 20

What is the management of a brain abscess?

Answer 20

Surgical drainage
Penicillin or ceftriaxone to cover streps
Metronidazole for anaerobes

Question 21

What are the common organisms responsible for brain abscess?

Answer 21

Strep anginosus 
Strep intermedius 
Strep constellatus 
Prevotella 
Bacteroides

Question 22

What are the HIV indicator illnesses associated with the brain?

Answer 22

Cerebral toxoplasmosis 
Aseptic meningitis/ encephalitis 
Primary cerebral lymphoma 
Cerebral abscess 
Dementia 
Cryptococcal meningitis

Question 23

What are the diagnostics for HIV indicator illnesses?

Answer 23

India ink, cryptococcal antigen 
Toxoplasmosis serology (IgG) 
JC virus PCR 
CMV PCR 
HIV PCR

Question 24

What are the investigations for Lyme disease?

Answer 24

Range of serological tests 
CSF lymphocytosis 
PCR of CSF 
MRI brain/spine 
Nerve condition studies

Question 25

What is the treatment for Lyme disease?

Answer 25

Prolonged antibiotic treatment (IV ceftriaxone, oral doxycycline)

Question 26

What are the symptoms of Lyme disease?

Answer 26

``` Fatigue Myalgia Headache Neck stiffness Fever, chills ```

Question 27

What are the clinical findings for neurosyphilis?

Answer 27

CSF lymphocytes increased | Evidence of intrathecal antibody production

Question 28

What is the treatment for neurosyphilis?

Answer 28

High dose penicillin

Question 29

What part of the CNS does poliomyelitis infect?

Answer 29

Anterior horn cells of lower motor neurones

Question 30

What are the clinical signs of poliomyelitis?

Answer 30

Asymmetric, flaccid paralysis in legs

Question 31

What is the post-exposure treatment for rabies?

Answer 31

Wash wound Give active rabies immunisation Give human rabies immunoglobulin

Question 32

What is the infection associated with tetanus?

Answer 32

Clostridium tetani | anaerobic gram positive bacillus, spore forming

Question 33

What is the effect of tetanus?

Answer 33

Blocks inhibition of motor neurones causing rigidity and spasm

Question 34

What causes botulism?

Answer 34

Clostridium botulinum

Question 35

What is the clinical presentation of botulism?

Answer 35

Descending symmetrical flaccid paralysis Respiratory failure Autonomic dysfunction

Question 36

What are the investigations for botulism?

Answer 36

Nerve conduction studies | Culture from derided wound

Question 37

What is the treatment for botulism?

Answer 37

Anti-toxin Penicillin/ metronidazole Radical wound debridment

Question 38

What are the clinical features of sporadic Creutzfeldt-Jakob disease?

Answer 38

Early behavioural abnormalities Rapidly progressive dementia Myoclonus