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Clinical Pathology > viral meningitis and encephalitis > Flashcards

viral meningitis and encephalitis Flashcards

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1
Q

what does “itis” mean

A

inflammation

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2
Q

define meningitis

A

inflammation of the meninges

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3
Q

define encephalitis

A

inflammation of the brain

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4
Q

define menigo-encephalitis

A

inflammation of the meninges and the brain

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5
Q

define aseptic meningitis

A

white cell count in CSF >5x 10^6/L

negative bacterial culture

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6
Q

commonest causes of aseptic meningitis

A

viral- most common
partially treta bacterial meningitis (so culture is negative but WBC is high).
Malignancy
Autoimmune conditions and drugs, Listeria, TB, Syphilis.

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7
Q

most common cause of viral meningitis

A

unknown-37%
Enterovirus
Herpes simplex virus

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8
Q

most common enetroviruses to cause viral encephalitis

A

Echovirus, coxsackie virus, parencho virus, enterovirus and polio

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9
Q

most common herpes virus to cause viral encephalitis

A

HSV1, HSV2 , varicella zoster

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10
Q

how doe pathogens cause viral meningitis

A

colonise mucosal surfaces
invade epithelial cells
replicate cells
disseminate and CNS invasion

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11
Q

how do pathogens invade the CNS

A

cerebral microvascular endothelial cells
choroid plexus epithelium- bloodstream.
spread along the olfactory nerve.

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12
Q

clinical features of viral meningitis.

A

fever, meningism, viral prodrome (lethargy, myalgia’s, arthralgia’s, sore throat ), diahorrhea and vommitting and rash.

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13
Q

what is meningism (what 3 symptoms does it involve`0

A

headahce, neck stiffness and photophobia

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14
Q

clinal features of viral meningitis in children

A

nuchal rigidity (neck stiffness), bulging anterior frontelle.

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15
Q

what 3 examinations are carried out on suspected patients with viral meningitis

A

kernigs sign
Brudzinskis sign
nuchal rididity

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16
Q

what is Kernigs sign

A

hip and knee flexed at 90, knee cannot be extended due to pain and stiffness in hamstrings.

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17
Q

what is Brudzinski’s sign

A

flexing neck causes hips and knees to flex at it reduces stretch on spinal cord and meninges

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18
Q

what blood investigations are carried out in viral meningitis

A

Blood test- FBC, U and E, CRP, clotting (before LP), blood culture, renal function (dehydration).

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19
Q

why might a CT be used in viral meningitis

A

look for raised intracranial pressure and other diagnosis of mass, lesion, subarachnoid haemorrhage.

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20
Q

why should a lumbar puncture not be carried on a patient with raised intracranial pressure.

A

removing the CSF can cause the brain to herniate through the foramen magnum

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21
Q

when should a lumbar puncture be carried out on a patient with suspected viral meningitis

A

ASAP
before antibiotics and CT
within 1 hr of admission.

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22
Q

what can the CSF obtained from a lumbar puncture be used for

A

– Microscopy, culture and sensitivity (MCS)
– Protein
– Glucose (CSF and blood glucose)
– Viral PCR

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23
Q

what is the WBC in bacterial meningitis

A

100-20,000 mm ^2

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24
Q

what is the WBC in viral meningitis

A

5-500 mm^2

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25
what is the glucose level in bacterial meningitis
26
what is the glucose level in viral meningitis
30-70 mg/dL
27
what is the protein level in bacterial meningitis
100-500 mg/dL
28
what is the protein level in viral meningitis
30-150 mg/dL
29
what microbiological investigations other than those obtained from CSF can be undertaken for viral meningitis
throat swab, stool sample | serology- Mumups, EBV/CMV/HIV
30
what is the treatment for viral meningitis
Mainly supportive therapy (e.g. analgesia and antipyretics) no antibiotics unless bacterial where you give IV cefotaxime. some treat HSV/VZV with aciclovir
31
is viral meningitis a notifiable condition
Yes
32
Commoest cause of meningitis in the UK is
enterovirus
33
what is the prognosis of enetrrovirus caused viral meningitis
full recovery.
34
common symptoms of enterovirus infection
fever, vomitting, anorexia, rash, upper respiratory tract symptoms.
35
what condition does HSV1 infection cause
encephalitis (cold sores)
36
what condition does HSV2 infection cause
meningitis (genital herpes)
37
define mollaret's meningitis and what organism causes it
recurrent aseptic meningitis and wide differential but major cause= HSV2
38
what does primary infection of VSV cause
chickenpox
39
what does secondary infection of VSV cause
shingles
40
does viral meningitis occur during chickenpox and shingles to not
most commonly not, but it can occur with it.
41
aciclovir is not used in what 2 pathogen caused viral meningitis
HSV and VZV
42
when do CNS symptoms in mumps meningitis
5 days after onset of parotitis
43
clinical features of mumps meningitis excluding for CNS symptoms
abdominal pain | Orchitis- inflammation of the testes
44
prevention of Mumps meningitis
vaccine
45
when does HIV meningitis occur
part of primary infection
46
clinical features associated with HIV meningitis
``` glandular fever Fever Lymphadenopathy Pharyngitis Rash ```
47
what causes viral encephalitis
unknown-37% herpes- HSV1 can be bacterial- acute disseminated encephamyophaty (damages myelin)
48
what part of a history is key to encephalitis and meningitis
travel history
49
clinical presentation of encephalitis
Major features- low GCS. Altered mental state (confusion, bizarre behaviour and even coma) Fever, headache, meningism (may be absent) +/- Focal neurology Seizures, weakness, dysphasia, aphasia, cranial nerve palsy and ataxia. Neuroexamination needed and get a collateral history from friend or relative to ask if they have noticed any confusion in the patient.
50
what investigations are carried out for viral encephalitis.
blood test- – FBC, U&E,CRP, clotting, (Blood cultures), Serology CT – likely to be necessary before LP- due to low GCS score focal neurology will need to be checked. ``` MRI – may see changes typical of HSV encephalitis Lumbar puncture: – Microscopy – Culture and sensitivity – Protein/glucose – Viral PCR ``` EEG: In HSV encephalitis 75% will show abnormal temporal lobe activity
51
In HSV encephalitis 75% will show abnormal activity in which lobe of the brain, what investigation is used to prove this
temporal lobe | EEG-electroencephalogram
52
What is the treatment for viral encephalitis.
• High dose IV aciclovir o 10mg/kg tds o 14-21 days
53
why is oral switch of acicolovir not recommended
long time period over which drugs might have to be taken.
54
what is the bimodal distribution of herpes encephalitis
50 yrs.
55
what signs are present in the neurological sequel of herpes encephalitis
– Paralysis – Speech loss – Personality change
56
what is the pathogenesis of herpes in causing viral encephalitis.
o Direct transmission of the virus along neural/olfactory pathways o Reactivation in the trigeminal ganglia (HSV1)
57
Is herpes simplex encephalitis more common on primary infection or reactivation
primary
58
define Acute focal necrotising encephalitis
brain tissue dies, increased ICP and increased Inflammation.
59
what pathogenic organism infection causes Acute focal necrotising encephalitis
herpes simplex
60
define Acute disseminated encephalomyelopathy
AUTOIMMUNE immune mediated CNS demyelination can follow viral infection or vaccine
61
what investigation is useful in (ADEM) Acute disseminated encephalomyelopathy
MRI
62
what is the main treatment for Acute disseminated encephalomyelopathy (ADEM)
Steroids and immunosuppression.

Clinical Pathology (45 decks)

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