Infections of the nervous system

Question 1

What is meningitis?

Answer 1

Inflammation/infection of the meninges

Question 2

What is encephalitis?

Answer 2

Inflammation/infection of the brain substance

Question 3

What is myelitis?

Answer 3

Inflammation/infection of the spinal cord

Question 4

What is the name given to the artificial distinction with a mixture of CNS infection?

Answer 4

encephalomyelitis

Question 5

Classic triad of clinical features of meningitis

Answer 5

fever, neck stiffness and altered mental status

Question 6

3 symptoms of meningism

Answer 6

neck stiffness
photophobia
nausea and vomiting

Question 7

How do you test neck stiffness?

Answer 7

passively bend neck forward and lift head up and should fall down but it does not in meningitis

Question 8

What kind of rash Is present in meningitis?

Answer 8

petechial non-blanching

Question 9

What is the rash in meningitis a hallmark of?

Answer 9

meningococcal meningitis (can also occur in viral in meningitis)

Question 10

Some symptoms of meningitis

Answer 10

cerebral dysfunction, cranial nerve palsy, focal neurological signs

Question 11

Differential diagnosis for meningitis

Answer 11

infective = bacterial, viral, fungal
Inflammatory = sarcoidosis
Drug induced = NSAIDS, IVIG
malignant = metastatic, haematological

Question 12

2 bacterial causes of meningitis

Answer 12

Neisseria meningitidis - meningococcus

streptococcus pneumoniae - pneumococcus

Question 13

Viral cause of meningitis

Answer 13

Enterovirus

Question 14

Give 2 differences between bacterial and viral encephalitis

Answer 14

viral onset is slower and the cerebral dysfunction is a more prominent feature

Question 15

Differential diagnosis of encephalitis

Answer 15

Infective = viral (HSV)
Inflammatory = limbic encephalitis
metabolic eg hyperglycaemia
migraine

Question 16

How many important antibodies are there in autoimmune encephalitis? What are they?

Answer 16

2
anti VGKC
Anti NMDA receptor

Question 17

What is the priority with meningitis and encephalitis?

Answer 17

exclude and treat infection

Question 18

Meningitis investigation

Answer 18

blood cultures and lumbar puncture

Question 19

Encephalitis investigation

Answer 19

blood culture, lumbar puncture, imaging scans, EEG

Question 20

2 contraindications of lumbar puncture

Answer 20

Focal symptoms or signs suggesting a focal brain mass

Reduced conscious level suggesting a raised ICP

Question 21

Why is glucose in CSF with bacterial meningitis reduced?

Answer 21

bacteria use glucose as a food source

Question 22

Compare CSF findings in bacterial and viral meningitis with white cell count

Answer 22

both increased
bacterial - neutrophils
viral - lymphocytes

Question 23

How is HSV encephalitis diagnosed?

Answer 23

PCR of CSF for viral DNA

Question 24

How is HSV encephalitis treated?

Answer 24

Aciclovir

Question 25

What do type 1 and type 2 HSV cause?

Answer 25

type 1 - cold sores | Type 2 - genital herpes

Question 26

Where is HSV latent in the CNS?

Answer 26

neurological ganglia

Question 27

What type of HSV usually causes encephalitis except in neonates?

Answer 27

1

Question 28

Do enterovirus cause gastroenteritis?

Answer 28

No

Question 29

How are enteroviruses spread?

Answer 29

faecal-oral

Question 30

Are enteroviruses a large family of DNA or RNA viruses?

Answer 30

RNA

Question 31

How are arbovirus encephalitides transmitted?

Answer 31

by vector (tick,mosquito) from a non human source

Question 32

What does arbo mean?

Answer 32

Arthropod borne

Question 33

Why is arbovirus encephalitides relevant to travel?

Answer 33

Common in other parts of the world and can be immunised to prevent

Question 34

What is a brain abscess?

Answer 34

Localised area of pus within the brain

Question 35

What is a subdural empyema?

Answer 35

Thin layer of pus between the dura and arachnoid mater membranes over the surface of the brain

Question 36

Clinical features of brain abscess/empyema

Answer 36

fever headache, focal signs eg seizure, dysphasia, hemiparesis

Question 37

What are the signs of raised ICP?

Answer 37

papilloedema, depressed conscious level

Question 38

What are common underlying sources of infection for a brain abscess/empyema?

Answer 38

sinusitis, dental, ear infection

Question 39

Causes of brain abscess and empyema

Answer 39

penetrating head injury spread of adjacent infection blood borne infection eg bacterial endocarditis Neurosurgical procedure

Question 40

Diagnosis of brain abscess/empyema

Answer 40

CT/MRI investigate source blood cultures biopsy and drainage of pus

Question 41

What are the 2 main organisms present in the mixture of empyema?

Answer 41

streptococci | anaerobes

Question 42

Management of brain abscess

Answer 42

1st line = surgical drainage penicillin for streps metronidazole for anaerobes

Question 43

What is HIV encephalopathy?

Answer 43

HIV related dementia

Question 44

Most common type of meningitis in HIV?

Answer 44

cryptococcal

Question 45

Diagnostics of HIV related illnesses

Answer 45

india ink - cryptococcal antigen - CSF makes circles HIV PCR JCV PCR toxoplasmosis serology (IgG)

Question 46

3 spirochaetes in the CNS

Answer 46

lyme disease, syphilis, leptospirosis

Question 47

Lyme disease - how is it transmitted?

Answer 47

vector borne - wooded areas

Question 48

Systems lymes disease affects

Answer 48

skin, rheumatological, MSK, ophthalmological, cardiac, neurological

Question 49

How many stages of lymes disease is there?

Answer 49

3

Question 50

Stage 1 characteristic bite at site of tick bite

Answer 50

erythema migrans

Question 51

How many organ systems are affected in stage 2 of lymes disease?

Answer 51

1 or more | usually neurological and MSK

Question 52

When does stage 3 of lymes disease occur?

Answer 52

after a period of latency

Question 53

Investigation of lymes disease

Answer 53

serological tests PCR of CSF EMG CSF lymphocytosis

Question 54

Treatment of lymes disease

Answer 54

prolonged antibiotic treatment for 3-4weeks

Question 55

What are the 3 stages of Neurosyphilis/syphilis

Answer 55

primary, secondary and latent

Question 56

What group of viruses are polioviruses and how many types are there?

Answer 56

enterovirus | 1,2,3

Question 57

In polio what has to be affected for there to be paralysis?

Answer 57

anterior horn cell of LMN

Question 58

What is rabies?

Answer 58

Acute infectious diseases of CNS affecting almost all mammals

Question 59

How is rabies transmitted to humans?

Answer 59

bite | salivary contamination of an open lesion

Question 60

How is rabies neurotropic?

Answer 60

enters peripheral nerves and migrates to CNS

Question 61

Symptoms of rabies

Answer 61

paraesthesia at sight of lesion | ascending paralysis and encephalitis

Question 62

Diagnosis of rabies encephalitis

Answer 62

culture, detection, PCR or serology

Question 63

Where is rabies encephalitis mainly found and what animals?

Answer 63

Africa/Asia | dogs and bats

Question 64

Pre-exposure prevention method of rabies

Answer 64

active immunisation with killed vaccine

Question 65

what 3 groups are given pre-exposure prevention of rabies?

Answer 65

bat handlers regular handlers of imported animals selected travellers to enzootic areas

Question 66

What is meant by enzootic?

Answer 66

Regularly affecting animals in a particular area or at a particular season

Question 67

Post exposure treatment of rabies

Answer 67

wash wound give active rabies immunisation give human rabies Ig if risk is high

Question 68

Is human rabies immunoglobulins active or passive immunisation?

Answer 68

passive

Question 69

What is the causative organism of tetanus?

Answer 69

clostridium tetani

Question 70

What type of bacteria is clostridium tetani and clostridium botulinum?

Answer 70

anaerobic gram positive spore forming bacillus

Question 71

What affects the NMJ in tetanus?

Answer 71

toxins produced by the bacteria

Question 72

What do the toxins in tetanus do to the NMJ?

Answer 72

block it and prevent inhibition of motor neurons

Question 73

Tetanus signs

Answer 73

rigidity and spasm

Question 74

Prevention of tetanus

Answer 74

immunisation - toxoid give combined with other antigens eg DPaT penicillin and IG for high risk wounds and patients

Question 75

Causative organism in botulism

Answer 75

clostridium botulinum

Question 76

What does the neurotoxin in botulism do and how does it work?

Answer 76

binds irreversibly to presynaptic terminal and prevent Ach release

Question 77

Where is clostridium botulinum naturally present?

Answer 77

soil, dust and aquatic environments

Question 78

3 modes of infection of botulism

Answer 78

infancy - intestinal colonisation food borne - outbreaks wound - drug users

Question 79

Incubation period of clostridium botulinum

Answer 79

4-14 days

Question 80

Presentation of botulism

Answer 80

ANS dysfunction - dilated pupils | descending symmetrical paralysis, respiratory failure

Question 81

How is botulism diagnosed?

Answer 81

nerve conduction studies toxin in blood culture from debrided wound

Question 82

Treatment of botulism

Answer 82

Anti-toxin (A,B,E) Penicillin/metronidazole radical wound debridement

Question 83

What is a prion?

Answer 83

transmissible protein particle

Question 84

Aetiology of CJD

Answer 84

sporadic, new variant, familial, acquired eg blood transfusion

Question 85

When should sporadic CJD be considered?

Answer 85

>60 | very rapidly progressive dementia

Question 86

What is new variant CJD linked to?

Answer 86

bovine - infected material | genetic susceptibility

Question 87

Investigation of CJD

Answer 87

MRI EEG CSF