Neurology - Infections Flashcards by Patrick Kilgannon

Q

What is Herpes simplex encephalitis?

A

Infection by herpes simplex virus that affects the temporal lobes.

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Q

Features of herpes simplex encephalitis.

A

fever
headache
psychiatric symptoms
seizures
vomiting
aphasia

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Q

Aetiology of herpes simplex encephalitis.

A

HSV-1 infecting temporal and inferior frontal lobes.

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Q

Diagnostic workup for herpes simplex encephalitis.

A

CSF (?lymphocytosis, elevated protein)
PCR (?HSV)
CT (medial temporal and inferior frontal changes)
EEG changes

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Q

Treatment of herpes simplex encephalitits.

A

Early IV aciclovir.

Left untreated mortality ~80%.

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Q

Species of malaria.

A

Plasmodium falciparum (most common)
Plasmodium vivax
Plasmodium ovale
Plasmodium malariea

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Q

Protective factors against malaria.

A

sickle cell trait
G6PD deficiency
HLA-B53
absence of Duffy antigens

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Q

Presentation of falciparum malaria.

A

feveer (cyclical)
n+v
splenomegaly
abdominal pain
diarrhoea
cough
generalised body aches
headache
dizziness
thrombocytopenia
AKI

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Q

Complications of falciparum malaria.

A

cerebral malaria (seizures, coma)
acute renal failure
acute respiratory distress syndrome
hypoglycaemia
DIC

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Q

Management of uncomplicated falciparum malaria.

A

Artesunate

plus

Mefloquine.

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Q

Features of severe falciparum malaria.

A

parasitaemia >2%
hypoglycaemia
acidosis
temperature >38°C
severe anaemia
acute complications

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Q

Management of severe falciparum malaria.

A

IV artesunate
exchange transfusion (parasite count >10%)

Haemodynamic instability usually indicates coexistant bacterial septicaemia; malaria rarely causes haemodynamic collapse.

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Q

Most common causes of meningitis.

0-3 months old.

A

GBS
E. coli
Listeria monocytogenes

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Q

Most common causes of meningitis.

3 months - 6 years old.

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

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Q

Most common causes of meningitis.

6-60 years old.

A

Neisseria meningitidis
Streptococcus pneumoniae

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Q

Most common causes of meningitis.

> 60 years

A

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

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Q

Most common causes of meningitis.

Immunocompromised.

A

Listeria monocytogenes

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Q

Features of meningitis.

Study These Flashcards

A

Triad of meningism:
- neck stiffness
- photophobia
- headache

Other fetures:
- fever
- nausea / vomiting
- non-blanching rash
- decreased consciousness

Q

Pre-hospital management of suspected bacterial meningitis.

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A

urgent hospital transfer
IM benzylpenicillin (as long as doesn’t delay transit to hospital)

Q

In-hospital management of suspected meningitis.

Study These Flashcards

A

Manage via ABCDE approach.

IV access > take bloods and blood culture
lumbar puncture
IV antibiotics
IV dexamethasone

Q

Contraindications to lumbar puncture.

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A

signs of severe sepsis or rapidly evolving rash
severe respiratory / cardiac compromise
significant bleeding risk
signs of raised ICP

Q

Signs of raised ICP.

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A

focal neurological signs
papilloedema
significant fontanelle bulging
DIC
signs of cerebral herniation

Q

CSF findings consistent with bacterial infection.

a) appearance

b) glucose

c) protein

d) white cells

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A

a) cloudy

b) low (<1/2 plasma)

c) high (>1g/l)

d) raised granulocytes

Q

CSF findings consistent with viral infection.

a) appearance

b) glucose

c) protein

d) white cells

Study These Flashcards

A

a) clear / cloudy

b) normal

c) normal / raised

d) raised lymphocytes

IV antibiotics in meningitis. a) 3-months to 50 years b) >50 years

a) cefotaxime b) cefotaxime + amoxicillin

Management of patients with signs of raised intracranial pressure.

- critical care input - secure airway - high flow oxygen - IV access (bloods / blood culture) - IV dexamethasone - IV antibiotics - arrange neuroimaging

Bloods taken in suspected meningitis.

- FBC - U&Es / renal function - glucose - lactate - clotting profile - CRP

If an LP is performed, what tests should be requested?

- glucose, protein, microscopy and culture - lactate - meningococcal and pneumococcal PCR

Management of contacts of meningitis.

People who have been exposed to a patient with confirmed bacterial meningitis within 7 days before symptom onset should be given prophylactic antibiotics. Single dose of ciprafloxacin used.

Causes of viral meningitis.

- non-polio enterovirus - mumps - HSV - HZV - CMV - HIV - measles

Risk factors for viral meningitis.

- extremes of age (<5 years, >60 years) - immunocompromised - IV drug user

Management of viral meningitis.

IV aciclovir if risk factors. Generally speaking, viral meningitis is self-limiting and will spontaneously resolve within 2 weeks.

Complications of meningitis.

- sensorineural hearing loss* - seizures - focal neurological deficit - sepsis - intracerebral abscess - brain herniation - hydrocephalus *all patients offered audiology assessment as soon as they have recovered, to assess for hearing impairment.

Examination findings consistent with meningitis.

Causes of brain abscess.

- extension of sepsis from middle ear / sinus - trauma - surgery to scalp - penetrating head injury - embolic events

Presenting symptoms of brain abscess.

Abscesses have considerable mass effect in the brain and raised ICP is common. - headache - fever - focal neurology (e.g. oculomotor nerve palsy, abducens nerve palsy) - nausea - papilloedema - seizures

Imaging for brain abscess.

- CT scanning

Management of brain abscess.

- surgical drainage - IV antibiotics - dexamethasone (pressure management)

Features of Lyme disease.

- bulls-eye rash (erythema migrans) - headache - lethargy - fever - arthalgia

Late features of Lyme disease. a) cardiovascular b) neuroloical

a) heart block; pericarditis; myocarditis b) facial nerve palsy; radicular pain; meningitis

Investigation of Lyme disease.

Clinical diagnosis if erythema migrans is present. ELISA test first line investigation if warranted.

Management of asymptomatic tick bites.

- remove tick if present - do not give abx unless symptomatic

Management of symptomatic tick bites.

- remove tick - doxycycline (or amoxicillin if pregnant)

Complication of treating Lyme disease.

Jarish-Herxheimer reaction - fever, rash and tachycardia after first dose of antibiotic.