Infections of the Nervous System

Question 1

34yr old woman presents to GP with short history of temp 38degC, headache and photophobia. What other examination tests might you conduct in your practice?

Answer 1

Kernig’s sign (neck flexion)

Brudzinski’s sign (passive neck flexion causes flexion of knees and hips)

Question 2

What are the contraindications to a Lumbar Puncture?

Answer 2

Signs of raised ICP: 
Papilloedema
Focal neurological deficit
Cranial nerve involvement
GCS<10
New onset seizures
Immunocompromised (HIV, AIDs)

Question 3

What are the 2 most common pathogens for Meningitis?

Answer 3

Meningococcus
Pneumococcus

(+/- viral pathogens - Enteroviruses, Herpes Simplex, Mumps, Influenza)

Question 4

64 year old male on the surgical ward presents with pyrexia, headache, papilloedema and complaining of the bright lights (photophobia). What investigation would you do to confirm your diagnosis?

Answer 4

Cerebral Abcess - CT/MRI

Question 5

Which WBC would be in abundance in bacterial meningitis CSF?

Answer 5

Neutrophils (leukocyte in viral or encephalitis)

Question 6

What is the confirmative diagnostic text for viral encephalopathy? And what’s the treatment?

Answer 6

Virological investigation - PCR

DO NOT WAIT to administer Aciclovir

Question 7

48 year old lady presents to her GP for a review appointment after suffering with encephilitis 2 months previously. She reports that 2 days ago she experienced a persistent painless flapping of her right arm. What may you need to counsellor her about? and treatments?

Answer 7

Some patients experience residual epilepsy and may require Anticonvulsants