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CP5 = CNS Infections > Viral Meningitis and Encephalitis > Flashcards

Viral Meningitis and Encephalitis Flashcards

1
Q

Define: Meningitis

A

Inflammation of the meninges

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2
Q

Define: Encephalitis

A

Inflammation of the brain

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3
Q

What white cell count and bacterial CSF state defines Aseptic Meningitis?

A

> White cell count >5x106/l

> Negative bacterial culture

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4
Q

What is the most common cause of Aseptic meningitis?

A

Viruses

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5
Q

Who does Viral meningitis commonly affect?

A

Children under 5

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6
Q

What is the most common cause of Viral Meningitis?

A

Enterovirus

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7
Q

What are the other causes of Viral Meningitis?

A

Herpes Viruses

Other viruses: Arbovirus, Mumps, HIV, Measles, Flu, Parainfluenza, Lymphocytic Choriomeningitis Virus.

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8
Q

How do viruses get inside the cell to replicate in V. Meningitis?

A

> Colonise the mucosal surface

> Infiltrate the epithelial cell surface

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9
Q

How does V.Meningitis disseminate and do CNS invasion?

A

Along the olfactory nerve.

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10
Q

What is the general clinical presentation of Viral Meningitis?

A

> Meningism - stiff neck, headache, photophobia
Fever
General ‘viral’ prodrome - lethargy, myalgia, arthralgia, sore throat, rash

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11
Q

What is the presentation of Viral Meningitis in children?

A

Usually have absent signs - but can have NUCHAL STIFFNESS AND BULGING ANTERIOR FRONTELLE

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12
Q

What is Kerning’s Sign? (HINT: K for Knee)

A

> Flex knee/hip by 90 degrees

> Can’t extend knee due to stiff hamstrings.

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13
Q

What is Brudzinski’s sign?

A

> Flex head towards chest.

> If nuchal rigidity = Manœuvre may involuntary cause flexion of hips and knees.

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14
Q

What investigations can be done for Viral Meningitis?

A

> Blood Tests
Viral PCR
Lumbar puncture - microbiology, culture, protein, glucose
Head CT - swellings, masses.

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15
Q

What are the CSF findings of Viral Meningitis?

A

> White cell count - Can be high, lots of neutrophils in first 24 hrs.
Mildly elevated protein levels
Glucose (CSF ratio: plasma) slightly low.

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16
Q

What other investigations can be done for Viral Meningitis?

A

> Stool sample/throat swab = Enteroviral PCR

> Serology = For herpes viruses and HIV

17
Q

What is the treatment for bacterial meningitis?

A

IV antibiotics e.f cefotaxime

18
Q

What are the symptoms of Enteroviral Meningitis?

A 
> Fever
> Vomiting
> Anorexia
> Rash 
> UR Tract
19
Q

Viral Encephalitis and cold sores are caused by what type of Herpes Simplex Virus?

A

HSV 1

20
Q

Genital herpes and Meningitis are caused by what type of Herpes Simple virus?

A

HSV 2

21
Q

After what primary infection can meningitis follow?

A

Genital lesions (caused by HSV 2)

22
Q

What is Mollaret’s Meningitis?

A

Recurrent Aseptic Meningitis.

HSV 2 = Major cause.

23
Q

When can meningitis occur with Varicella Zoster virus?

A

During :

1) Primary chickenpox infection
2) Secondary shingles infection
3) After vaccine

24
Q

In what percentage of cases does Mumps meningitis occur?

A

10-30%

25
Q

How soon after parotitis (characteristic of Mumps) do CNS symptoms occur?

A

~5 days

26
Q

What are the characteristic symptoms of mumps meningitis?

A

> Orchitis (testicle swelling)

> Abdo pain

27
Q

What are the assc features of HIV meningitis?

A 
> Fever
> Rash
> Pharyngitis
> Lymphadenopathy 
= Self- limiting symptoms.
28
Q

What is the main cause of Viral Encephalitis?

A

HSV 1

29
Q

What are the other causes of Viral Encephalitis?

A

> Other viruses
Bacteria
Acute disseminated encephalopathy (ADEM)

30
Q

What is the clinical presentation of Viral Encephalitis?

A 
> Same 'Meningism' as Viral Meningitis 
> Altered mental state
> Seizure
> Weakness
> Dysphasia/Aphasia 
> Cranial nerve palsy 
> Ataxia
31
Q

What are the investigations of Viral Encephalitis?

A

> Same as meningitis - Blood tests, CT, Lumbar puncture
Electroencephalography - in 75% of HSV caused = abnormal temporal lobe activity.
CSF FINDINGS SAME IN VIRAL MENINGITIS AND VIRAL ENCEPHALITIS

32
Q

What is the treatment of Viral Encephalitis?

A

High dose Acyclovir ~ 2 weeks.

33
Q

What is the epidemiology for Viral Encephalitis?

A

50 years - equal sexes spread.

34
Q

What is the pathogenesis for VE?

A

Can cause acute focal necrotising encephalitis –> brain tissue swells

35
Q

What are survivors of VE sometimes left with? (HINT: THINK Neurological)

A

Paralysis, speech loss, personality change.

36
Q

What is Acute Disseminated Encephalopathy?

A

Immune-mediated CNS demyelination

37
Q

What does ADEM follow?

A

Viral illness or vaccination

38
Q

Unlike Viral Encephalitis, what should ADEM be treated with?

A

Steroids/other immunosuppressants.

CP5 = CNS Infections (3 decks)

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