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Infections of the Nervous System Flashcards

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1
Q

What may untreated infection cause?

A

Brain herniation and death

Cord compression and necrosis with subsequent permanent paralysis

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2
Q

What are the common infections of the CNS?

A

Encephalitis, meningitis, meningoencephalitis, encephalomyelitis, epidural abscesses, neuritis, sepsis syndrome

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3
Q

What are the types of meningitis?

A

Acute pyogenic = bacterial
Acute aseptic = viral
Acute focal suppurative infection = brain abscess, subdural/epidural empyema
Chronic bacterial infection = TB

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4
Q

What is acute encephalitis?

A

Infection of the brain parenchyma

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5
Q

What would indicate a diagnosis of pyogenic meningitis?

A

Thick layer of suppurative exudate that covers leptomeninges over surface of brain = exudate in basal and convexity surface

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6
Q

How does pyogenic meningitis appear microscopically?

A

Neutrophils in subarachnoid space

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7
Q

How is pyogenic meningitis treated?

A

Ceftriaxone and dexamethosone

Amoxicillin if Listeria suspected

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8
Q

What are some features of viral meningitis?

A 
Common = late summer/autumn
Usually enteroviruses (e.g ECHO virus)
Treated supportively as self limiting
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9
Q

How is viral meningitis diagnosed?

A

Viral stool culture

Throat and CSF swab

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10
Q

How is encephalitis treated?

A

Aciclovir = if delay predicted in getting test results then give preemptively

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11
Q

What are the features of encephalitis?

A

Stupor, coma, seizures, partial paralysis, confusion, psychosis, speech and memory symptoms, meningismus = insidious onset but may be sudden

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12
Q

What investigations are done for encephalitis?

A

Lumbar puncture, EEG and MRI

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13
Q

What are the symptoms of bacterial meningitis?

A

Fever, cold extremities, vomiting, drowsy, confusion, severe muscle pain, non-blanching rash, headache, stiff neck, photophobia

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14
Q

What organisms cause bacterial meningitis in children?

A

Neonates = listeria, group B strep, ecoli
Children = h, influenzae
Age 10-21 = neisseria meningitidis

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15
Q

What organisms cause bacterial meningitis in adults?

A

Age >21 = strep pneumoniae

Age >65 = strep pneumoniae

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16
Q

What are some risk factors for bacterial meningitis?

A

Decreased cell mediated immunity = listeria
Neurosurgery/head trauma = staph, gram negative rods
Cribrifrom plate fracture = strep pneumoniae

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17
Q

How common are complications from bacterial meningitis?

A

Very common = 25% of people who survive meningitis and septicaemia will life with life altering complications

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18
Q

What are some complications of bacterial meningitis?

A

Purulence, invasion, cerebral oedema, ventriculitis and hydrocephalus

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19
Q

What are some features of the purulence that arises from bacterial meningitis?

A

Clusters at base of brain
Convexities of rolandic and sylvian sulci
Exudate around nerves = especially CN III and VI

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20
Q

How can bacterial meningitis arise?

A

Nasopharyngeal colonisation
Direct extension of bacteria
Spread from remote foci of infection elsewhere

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21
Q

What organisms cause bacterial meningitis in immunocompromised patients?

A

Strep pneumoniae, staph aureus, listeria monocytogenes, m. tuberculosis, nocardia asteroides, cryptococcus neoformans

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22
Q

What causes meningococcal meningitis?

A

Neisseria meningitis = found in throats of healthy carriers

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23
Q

How does neisseria meningitis gain access to the meninges?

Study These Flashcards
A

Probably via the bloodstream = bacteria may be found in leukocytes in CSF

24
Q

What are some features of meningococcal meningitis?

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A

Symptoms are caused by endotoxin

Most often occurs in children

25
Where can neisseria meningitis infection occur from?
Local disease, meningitis with septicaemia or fulminant septicaemia
26
What does haemophilus influenzae require for growth?
Blood factors
27
How many types of haemophilus influenzae are there?
Six types based on capsule differences = type b is most common cause of meningitis in children <4
28
What kind of vaccine is available for haemophilus influenzae meningitis?
Conjugated vaccine directed against the capsular polysaccharide antigen
29
Where is strep pneumoniae commonly found?
The nasophaynx = causes pneumococcal meningitis
30
What patients tend to get strep pneumoniae meningitis?
Hospitalised patients, patients with CSF skull fracture, diabetics, alcoholics and young children May be related to CNS devices like cochlear implants
31
Is there a vaccine for pneumococcal meningitis?
Yes = new conjugate vaccine has been developed
32
What are some features of listeria monocytogenes?
Gram positive bacilli Sporadic cases but on the rise Mainly causes bacteraemia illness
33
What patients get listeria meningitis?
Neonates, patients >55 and those who are immunosuppressed (especially malignancy)
34
What is the antibiotic of choice for listeria?
IV ampicillin or amoxicillin
35
How does tuberculous meningitis occur?
Due to reactivation of latent infection or in elderly patients
36
What are some features of tuberculous meningitis?
Often non-specific ill health Previous TB on CXR or poor yield from CSF High morbidity if not treated
37
What is the treatment for tuberous meningitis?
Isoniazid and rifampicin | May add pyrazinamide and ethambutol
38
What are some features of cryptococcal meningitis?
Fungal = mainly seen in HIV when CD4 < 100 Disseminated infection Subtle neurological presentation and aseptic picture on CSF Serum and CSF cryptococcal antigen
39
How is cryptococcal meningitis treated?
IV amphotericin b/flucytosine and fluconazole
40
What are the signs of bacterial meningitis?
Fever, stiff neck, alteration in consciousness
41
When should you be cautious about performing a lumbar puncture?
If increased ICP is possible and in the setting of delerium
42
What are some features of a lumbar puncture?
Utilise sitting position if necessary Measure opening pressure if flow is fast Give antibiotics before doing the procedure
43
How is the CSF obtained from a lumbar puncture sent for interpretation?
Tube 1 = haematology Tube 2 = microbiology Tube 3 = chemistry Tube 4 = haematology
44
What is PCR used for?
To differentiate between causes of meningitis
45
Can bacterial meningitis be culture negative?
Yes
46
What does aseptic meningitis refer to?
Non-pyogenic bacterial meningitis
47
What is the spinal fluid like in aseptic meningitis?
Low number of WBC, minimally elevated protein and normal glucose
48
What are the infectious causes of aseptic meningitis?
HSV 1 and 2, syphilis, listeria, TB, cryptococcus, leptospirosis, cerebral malaria, Lyme disease
49
What are the non-infectious causes of aseptic meningitis?
Carcinomatous, sarcoidosis, vasculitis, dural venous sinus thrombosis, migraine
50
What patients should go for a CT before having a lumbar puncture done?
Immunocompromised, history of CNS disease, new onset seizure, papilloedema, abnormal level of consciousness, focal neurological deficit
51
What are the red flags in meningitis?
GCS < 12 or fall in GCS >2 Focal neurology, seizure or shock Bradycardia and hypertension Papilloedema
52
When are steroids indicated?
In all patients with bacterial meningitis (don't gove for viral)
53
When do steroids have the biggest benefit?
Treating pneumococcal meningitis
54
What are the contraindications for using steroids to treat meningitis?
Post surgical meningitis, severely immunocompromised, meningcoccal/septic shock, steroid hypersensitivity
55
Do Public health need to be notified of meningitis cases?
Yes
56
What are close contacts of meningitis cases given as prophylaxis?
Ciprofloxacin

Neurology (48 decks)

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