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 brain substance

Question 3

What is myelitis?

Answer 3

Inflammation/infection of the spinal cord

Question 4

What is the classical triad of meningitis presentation?

Answer 4

Fever
Neck stiffness
Altered mental status

Question 5

What is meningism?

Answer 5

Neck stiffness
Photophobia
Nausea
Vomiting

Question 6

What is a petechial skin rash?

Answer 6

Petechiae are tiny purple, red, or brown spots on the skin. They usually appear on your arms, legs, stomach, and buttocks
Won’t go pale if you press them; a normal rash would

Question 7

What are some bacterial causes of meningitis?

Answer 7

Neisseria meningitidis
Streptococcus pneumoniae
Haem influenzae

Question 8

What are some viral causes of meningitis?

Answer 8

Enteroviruses

Question 9

How may encephalitis present?

Answer 9

Flu-like prodrome
Progressive headache with associated fever
Progressive cerebral dysfunction including but not limited to confusion and memory disturbance
Seizures

Question 10

What are the 2 important antibodies associated with auto-immune encephalitis?

Answer 10

Anti-voltage gated potassium channel (Anti-VGKC)

Anti-NMDA receptor

Question 11

What would be some of the signs of auto-immune encephalitis associated with Anti-VGKC?

Answer 11

Frequent seizures
Amnesia
Altered mental state

Question 12

What would be some of the signs of auto-immune encephalitis associated with Anti-NMDA receptor?

Answer 12

Flu like prodrome
Prominent psych features
Altered mental state
Seizures

Question 13

What are some useful investigations for meningitis?

Answer 13

Blood cultures
Lumbar puncture
No need for imaging if LP is feasible

Question 14

What are some useful investigations for encephalitis?

Answer 14

Blood cultures
CT/MRI
LP
EEG

Question 15

What may contraindicate a lumbar puncture?

Answer 15

Focal symptoms suggesting a brain mass

Reduced conscious level suggesting raised ICP

Question 16

How would CSF composition change in bacterial meningitis?

Answer 16

Increased opening pressure
High cell count (neutrophils)
Reduced glucose
High protein

Question 17

How would CSF composition change in viral meningitis and encephalitis?

Answer 17

Normal/increased opening pressure
High cell count (lymphocytes)
Normal glucose
Slightly increased protein

Question 18

What is the most common cause of encephalitis in Europe?

Answer 18

Herpes Simplex

Question 19

How is herpes simplex encephalitis diagnosed ?

Answer 19

PCR

CSF for viral DNA

Question 20

How is herpes simplex encephalitis treated?

Answer 20

Aciclovir

Question 21

Through which route are enteroviruses usually spread?

Answer 21

Faecal-oral

Question 22

What is a common cause of viral encephalitis in other parts of the world? (Significant if patient is well travelled)

Answer 22

Arbovirus encephalitides

Question 23

How are brain abscesses managed?

Answer 23

Surgical drainage if possible
Penicillin to cover streps
Meronidazole for anaerobes

Question 24

What is cryptococcal meningitis caused by?

Answer 24

Cryptococcus neoformans

Question 25

Which bacteria causes Lyme Disease?

Answer 25

Borrelia burgoferi

Question 26

Which bacteria causes Syphilis?

Answer 26

Treponema pallidum

Question 27

Which bacteria causes leptospirosis?

Answer 27

Leptospira interrogans

Question 28

What are some useful tests in Lyme disease?

Answer 28

CSF lymphocytosis PCR of CSF MRI EMG

Question 29

What is used to treat Lyme disease?

Answer 29

Prolonged antibiotic treatment IV ceftriaxone Oral doxycycline

Question 30

What are some viral causes of poliomyelitis?

Answer 30

Poliovirus types 1,2,3 | All enteroviruses

Question 31

How is Rabies transmitted to humans?

Answer 31

By bite or salivary contamination of an open lesion

Question 32

Which bacteria causes tetanus?

Answer 32

Clostridium tetani