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Year 2 - Nervous > Infections of the nervous system > Flashcards

Infections of the nervous system Flashcards

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1
Q

What 3 symptoms does meningism refer to

A

Neck stiffness
Photophobia
Headache

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2
Q

Class triad of meningitis symptoms

A

Neck stiffness
Fever
Altered mental status

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3
Q

Symptoms (4) /signs (5) of meningitis

A 
Symptoms:
NECK STIFFNESS
Progressive headache
Nausea
vomiting

Signs:
FEVER
ALTERED MENTAL STATUS
Photophobia
Meningism = neck stiffness, photophobia + headache +/- nausea/ vomiting
Petechial skin rash (in meningococcal meningitis)

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4
Q

Meningococcal meningitis can present with what skin feature

A

Petechial skin rash

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5
Q

Bacterial/viral causes of meningitis

A

Bacterial - neisseria meningitidis (meningococcus), streptococcus pneumoniae (pneumococcus)

Viral - enteroviruses

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6
Q

Meningitis investigations (3)

A

Blood culture + gram stain

Lumbar puncture + CSF culture
-CSF BACTERIAL CULTURE IS GOLD STANDARD FOR BACTERIAL MENINGITIS

CT/MRI - don’t need this if LP not contra-indicated

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7
Q

When not to do an LP + why

A

When there are signs and symptoms to suggest an intracranial mass lesion or if there’s a known brain lesion as it may cause herniation syndrome

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8
Q

Microbiological features of CSF in BACTERIAL meningitis (4)

A

Increased opening pressure >25cm H2O
High cell count (neutrophils)
Low CSF glucose (<40% of serum glucose)
High CSF protein (–> cloudy CSF)

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9
Q

Microbiological features of CSF in VIRAL meningitis (4)

A

Opening pressure – normal/increased
Cell count – high (LYMPHOCYTES)
CSF glucose – normal (60% of blood glucose)
CSF protein – slightly increased

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10
Q

Commonest enterovirus that causes viral meningitis

A

Coxsackievirus

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11
Q

Definition of encephalitis

A

Inflammation of brain substance

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12
Q

Symptoms (2) /signs (4) of encephalitis

A

Symptoms:
Preceding FLU-LIKE symptoms (cough, sore throat, runny nose etc)
Progressive headache

Signs:
Fever
Cerebral dysfunction - CONFUSION, abnormal behaviour, memory disturbance, decreased consciousness
SEIZURES
Focal symptoms/signs
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13
Q

Causes of encephalitis (3)

A

Viral - herpes simplex virus, arbovirus

Autoimmune

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14
Q

Investigations of encephalitis (6)

A 
Blood culture 
CT +/-MRI
Lumbar puncture + CSF culture
EEG
CSF PCR
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15
Q

For all suspected viral encephalitis, what is the empirical treatment

A

Aciclovir

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16
Q

Pathophysiology of autoimmune encephalitis

-2 autoantibodies

A

2 antibodies attacking receptors in brain:

  • Anti-VGKC (voltage gated potassium channel) antibodies
  • Anti-NMDA antibodies,
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17
Q

Encephalitis typically presents with what features (5)

A 
Presents with acute onset of a: febrile illness (Fever)
altered mental status
headache, 
seizures,
focal neurological signs
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18
Q

Microbiological features of CSF in VIRAL encephalitis (4)

A

Opening pressure – normal/increased
Cell count – high (LYMPHOCYTES)
CSF glucose – normal (60% of blood glucose)
CSF protein – slightly increased

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19
Q

Viral encephalitis most commonly is caused by what virus

A

HSV

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20
Q

Encephalitis is a rare complication of which type of HSV

A

Type 1 HSV

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21
Q

Name 3 examples of HSVs

A

varicella zoster virus (VZV),
epstein barr virus (EBV),
cytomegalovirus (CMV)

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22
Q

Main diagnostic investigation of viral encephalitis

A

CSF PCR for viral DNA

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23
Q

Treatment of bacterial meningitis (4)

  • empirical antibiotics (2)
  • other medical
A

Empirical antibiotics for >1 months if <50yrs:
IV ceftriaxone + IV vancomycin

IV dexamethasone

Supportive care

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24
Q

Treatment of encephalitis (2)

A

Aciclovir + supportive care (treat symptoms - fever etc)

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25
What is a brain abscess
Localised area of pus in brain
26
What is a subdural empyema
Layer of pus between dura and arachnoid
27
Brain abscesses can cause what type of meningitis - but rarely bacterial meningitis
Reactive meningitis
28
Abscess vs empyema
Abscess is a collection of pus anywhere in the body, usually inside an organ or under the skin Empyema is a collection of pus in body cavities, e.g. pleural cavity or between layer of meninges
29
Symptoms (1) /signs (5) of brain abscess/empyema
Symptoms: Headache ``` Signs: Fever Focal symptoms/signs (focal neurological deficit) Cranial nerve palsy Signs of raised ICP -Papilloedema -Decreased conscious level Meningism ```
30
Causative microbes of brain abscess (3) + name 2 bacteria that commonly cause brain abscesses
Bacterial - often a mix of strep milleri & anaerobes Fungal Parasitic
31
5 risk factors for brain abscess
``` Sinusitis Dental infection Otitis media Meningitis Recent neurosurgery ```
32
Bacterial brain abscess treatment (5) + specify which of the empirical antibiotics is targeted towards anaerobes
Empirical antibiotics: IV: Vancomycin + Metronidazole - for anaerobes + Ceftriaxone Anticonvulsant If doesn't respond to antibiotics then: surgical drainage
33
Brain abscess investigations - imaging (2) - bloods (4)
CT/MRI Blood culture FBC - elevated WBCs ESR - elevated CRP - elevated Biopsy of abscess
34
Name 3 conditions caused by spirochaetes (GRAM -VE)
Lyme disease Syphilis Leptospirosis
35
Name the spirochete causing lyme disease
Borrelia burgdorferi
36
Transmission of lyme disease
Vector borne - e.g. tick
37
Most common sign of Lyme disease
Erythema migrans - expanding red rash at site of tick bite
38
How many stages are there in lyme disease
3
39
Describe stage 1 of lyme disease (+ symptom /signs)
Early localised infection in 1st month ``` FLU like symptoms: Fever, headache, myalgias, fatigue, arthralgias ``` Signs: Erythema migrans - expanding rash
40
Describe stage 2 of lyme disease + name 2 ways it spreads + name 3 systems it can start to affect
``` Early disseminated (spread) infection -characterised by DIFFUSE macular-papular rash all over (esp hands and soles and chest) ``` Blood or lymphatic spread MSK, nervous, cardiovascular
41
Name 5 complications of lyme disease (i.e. when it's spread to other systems)
Radiculopathy Myelopathy Atrioventricular (AV) block - specifically 3rd degree heart block Late complications: Encephalomyelitis Peripheral neuropathy
42
Describe stage 3 lyme disease
= chronic version of stage 2 (disseminating infection via blood or lymph to other body systems) Further impairment of MSK, nervous and cardio systems - 3rd degree heart block - arthritis
43
Investigations of lyme disease (2)
Blood serology - ELISA (to detect antibody to B. burgdorferi) Immunoblot test - lyme specific IgM and IgG (detecting antibodies to proteins of B.burgdorferi) - confirms a positive ELISA
44
Lyme disease treatment (2) | -medical
Oral doxycycline (antibiotic) + IV ceftriaxone (only if high grade heart block or CNS complications)
45
Name the spirochaete (type of bacteria) that causes syphilis
Treponema pallidum
46
Describe how neurosyphilis arises from syphilis
Primary stage --> secondary stage --> latent --> tertiary stage (= neurosyphilis) Tertiary stage occurs after years of primary infection; is uncommon
47
2 ways syphilis is spread (2)
Sexual | Congenital (mother to baby)
48
2 main signs of primary syphilis (usually asymptomatic; only signs present) + symptoms (2) /signs (4) of secondary syphilis
Signs: Ulcer (chancre) often on genital area - firm, round, painless - PRIMARY Lymphadenopathy - PRIMARY Symptoms : Fatigue - secondary Malaise - secondary ``` Signs: Diffuse rash all over - secondary Fever - secondary Myalgia - secondary Arthralgia - secondary ```
49
Latent stage of syphilis is usually
Asymptomatic
50
Syphilis investigations (3) + how long do you have to wait before serology can be detected
Non-treponemal specific serology - venereal disease research laboratory test (VDRL) or rapid plasma reagin test Treponemal specific serology/antibodies Lumbar puncture + CSF analysis 5-6 weeks
51
Syphilis treatment | -medical combo (2)
Penicillin + prednisolone If penicillin allergic: Oral doxycycline + oral prednisolone
52
Name the spirochaete (bacteria) causing leptospirosis
Leptospira interrogans
53
Name post infective inflammatory syndromes in the CNS and PNS
CNS: acute disseminated encephalomyelitis (post-infectious encephalitis) PNS: Guillain barre syndrome
54
Name a prion disease
CREUTZFELDT-JAKOB DISEASE (CJD) - very rare
55
What is Creutzfeldt-Jakob disease caused by
Prions (proteinaceous infectious particles) - misshaped proteins that clump in the brain --> neurodegeneration
56
What are prion diseases also known as
Transmissible spongiform encephalopathies
57
Name 3 forms of CJD
Sporadic (85%) Genetic Acquired
58
Signs of CJD (5)
Rapidly progressive dementia/cognitive impairment Aphasia behavioural/psychiatric changes - depression, anxiety visual disturbances - double vision, hallucinations ataxia - difficulty in balance, muscle co-ordination and speech
59
What does CJD often present with neurologically
Rapidly progressive dementia
60
What is aphasia
Difficulty comprehending and expressing language
61
What is ataxia
Lack of co-ordination of muscle movements, balance and speech
62
Name a type of acquired CJD
New variant CJD
63
How is new variant CJD acquired
Through ingestion of prion-infected beef
64
Sporadic CJD usually affects what age group
60s
65
Variant CJD usually affects what age group
Late 20s (so much younger compared to sporadic CJD which affects 60s)
66
Investigations of CJD (3)
MRI brain EEG LP + CSF analysis
67
Name 3 neurological diseases that can be prevented with vaccines
Poliomyelitis Rabies Tetanus
68
Difference between active and passive immunisation
Active immunity involves your bodies direct response to an unknown pathogen by producing its own antibodies Passive immunity is an immune response which involves antibodies obtained from outside the body
69
Describe the natural + artificial examples of - active - passive immunity
ACTIVE: - Natural form of active immunity is the normal process of an individual contracting an infection and their immune system responding - Artificial form of active immunity is immunisation, where an individual is deliberately exposed to a weakened form of a particular pathogen in order to elicit an immune response PASSIVE: - Natural form of passive immunity is antibodies transferred in breast milk as mentioned - Artificial form of passive immunity is the use of antidotes such as that for rabies where specific antibodies are injected into an infected individual.
70
What type of immunisation - active or passive - is given for poliomyelitis to prevent it
Inactivated poliovirus vaccine =Active (specifically artificial active)
71
Spread of polio
Faecal-oral (ingesting infected faces)
72
Spread of rabies (2)
Animal bites from infected animal | Salivary contamination of open wound
73
What does the rabies virus cause
Acute viral encephalomyelitis
74
Describe the prevention (1) and post exposure treatment of rabies (3)
Prevention with artificial active immunisation (with an inactivated vaccine) Post exposure: Clean wound Give artificial active immunisation again If have never been immunised for rabies, give artificial passive immunisation (human rabies immunoglobulin)
75
Rabies investigations (3)
Saliva PCR + viral culture Bloos serology CSF analysis
76
Name the bacteria that causes tetanus
Clostridium tetani
77
Pathophysiology of tetanus
Clostridium tetani produces toxins which act at the NMJ and blocks inhibition of post synaptic motor neurons by preventing the inhibitory neurotransmitter GABA from being released
78
Symptoms (2)/ signs (3) of tetanus
Signs: trismus (Reduced jaw opening) muscle rigidity, tonic muscle spasms (rises sardonic) Symptoms: Back pain Dysphagia
79
Describe prevention (1) and post exposure (5) treatment of tetanus
Prevention with artificial active immunisation (tetanus toxoid (toxoid vaccine)) ``` Post exposure: Clean wound Antibiotics Benzodiazepine Give tetanus toxoid again Passive immunisation - tetanus immunoglobulin ```
80
Name the causative agent of botulism
Clostridium botulinum
81
Is there a preventative vaccine for botulism
No
82
Post exposure treatment for botulism (4)
Supportive care Botulism anti-toxin Wound cleansing if wound involved Penicillin or metronidazole if wound involved
83
What test helps to confirm suspected VIRAL meningitis, i.e. differentiates it from bacterial meningitis
CSF PCR for viral DNA
84
Lyme disease can cause what heart problem
3rd degree heart block

Year 2 - Nervous (39 decks)

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