Questions and Answers
What is the primary mechanism by which pathogens breach the blood-brain barrier and cause CNS infections?
Which of the following is a characteristic feature of CNS infections in terms of epidemiology?
A 35-year-old patient presents with fever, headache, and confusion. What is the most sensitive diagnostic test for CNS infections in this patient?
A patient with a CNS infection exhibits signs of seizures, altered mental status, and focal neurological deficits. What is the most likely etiology of this clinical presentation?
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What is the primary goal of management in CNS infections?
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What is the most common symptom of meningitis in newborns and infants?
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What type of meningitis is caused by fungi such as Cryptococcus and Aspergillus?
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What is the recommended vaccination schedule for the Meningococcal conjugate vaccine?
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What is the primary purpose of a lumbar puncture in the diagnosis of meningitis?
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What is the primary treatment for bacterial meningitis?
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What type of meningitis is caused by viruses such as enteroviruses, herpesviruses, and West Nile virus?
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What is the recommended vaccination schedule for the Pneumococcal conjugate vaccine?
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What is the primary goal of imaging tests in the diagnosis of meningitis?
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What type of meningitis is typically less severe than bacterial meningitis?
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What is the primary treatment for fungal meningitis?
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Which of the following symptoms specifically indicates increased intracranial pressure and irritation of the meninges?
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A 40-year-old patient presents with altered mental status. Which other symptom would most likely support a diagnosis involving CNS infection?
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Which symptom is least likely to be directly associated with a CNS infection?
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In the context of CNS infections in adults, what does 'altered mental status' typically refer to?
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Which of the following pairs of symptoms is most indicative of a CNS infection in adults?
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Which symptom is common to both age groups?
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Which of the following is a symptom that specifically affects infants and is difficult to detect?
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Which symptom is uniquely listed under the 'over age 2' category?
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What symptom might indicate a rapidly spreading rash in children over age 2?
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What is a common symptom in infants that involves a lack of responsiveness or movement?
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What characterizes the appearance of cerebrospinal fluid in pyogenic bacterial meningitis?
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Which type of meningitis is associated with a very low glucose level in the CSF?
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What is the typical protein level in the cerebrospinal fluid for normal CSF?
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Which type of meningitis shows a clear or slightly turbid appearance and high protein levels in the CSF?
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Which type of meningitis typically results in raised lymphocytes in the cerebrospinal fluid?
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Which cerebrospinal fluid finding is most indicative of bacterial meningitis?
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What type of white cell predominates in the cerebrospinal fluid of a patient with bacterial meningitis?
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Which pattern of glucose concentration in cerebrospinal fluid is typically observed in bacterial meningitis?
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Which diagnostic technique is commonly positive in bacterial meningitis?
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Which cerebral spinal fluid findings would NOT be expected in bacterial meningitis?
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Which of the following Glasgow Coma Scale scores is an indication against performing a lumbar puncture?
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What is a sign of raised intracranial pressure that contraindicates lumbar puncture?
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Which of the following is NOT considered a focal neurological sign that contraindicates lumbar puncture?
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Bradycardia and hypertension together are indicative of what condition that contraindicates lumbar puncture?
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Which of the following eye signs would contraindicate a lumbar puncture?
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What does a verbal score of 3 on the Glasgow Coma Scale indicate?
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Which motor score on the Glasgow Coma Scale corresponds to 'Obeys commands'?
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What eye response score does 'Opens eyes spontaneously' receive on the Glasgow Coma Scale?
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What does a motor response score of 2 indicate on the Glasgow Coma Scale?
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Which verbal score would be given to a patient who is 'Oriented, converses normally'?
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Which eye response is given a score of 2 on the Glasgow Coma Scale?
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Study Notes
Symptoms of Meningitis
- Fever, headache, stiff neck, nausea and vomiting, sensitivity to light, and confusion or disorientation are common symptoms
- Severe symptoms include seizures, difficulty speaking or walking, weakness or numbness in the face or extremities, and rash or skin lesions
- Newborns and infants may show irritability, refusal to eat, high-pitched crying, bulging soft spot on the head, and stiffness or floppiness
Types of Meningitis
- Bacterial meningitis is caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, and is the most severe and potentially life-threatening type
- Viral meningitis is caused by viruses such as enteroviruses, herpesviruses, and West Nile virus, and is typically less severe than bacterial meningitis
- Fungal meningitis is caused by fungi such as Cryptococcus and Aspergillus, and typically occurs in people with weakened immune systems
- Parasitic meningitis is caused by parasites such as Naegleria fowleri, and aseptic meningitis is caused by non-infectious agents such as medications or cancer
Vaccination
- Available vaccines include Meningococcal conjugate vaccine (MenACWY), Meningococcal B vaccine (MenB), and Pneumococcal conjugate vaccine (PCV)
- Recommended vaccination schedules include Meningococcal conjugate vaccine at 11-12 years old with a booster dose at 16 years old, Meningococcal B vaccine at 16-23 years old with a series of 2-3 doses, and Pneumococcal conjugate vaccine at 2, 4, 6, and 12-15 months old with a booster dose at 5 years old
Diagnosis
- Physical examination involves assessing vital signs, neurological function, and overall health
- Imaging tests such as CT or MRI scans are used to rule out other conditions
- Lumbar puncture is used to collect cerebrospinal fluid to analyze for signs of infection
- Laboratory tests include blood cultures to identify the causative organism, and PCR or other molecular tests to detect viral or fungal infections
Treatment Options
- Bacterial meningitis is treated with antibiotics such as ceftriaxone or vancomycin, and supportive care such as fluid replacement, oxygen therapy, and pain management
- Viral meningitis is treated with supportive care such as fluid replacement, pain management, and anti-nausea medications, and antiviral medications in some cases
- Fungal meningitis is treated with antifungal medications such as amphotericin B, and supportive care such as fluid replacement, oxygen therapy, and pain management
Symptoms of Meningitis
- Common symptoms: fever, headache, stiff neck, nausea and vomiting, sensitivity to light, and confusion or disorientation
- Severe symptoms: seizures, difficulty speaking or walking, weakness or numbness in the face or extremities, and rash or skin lesions
- Newborns and infants: irritability, refusal to eat, high-pitched crying, bulging soft spot on the head, and stiffness or floppiness
Types of Meningitis
- Bacterial meningitis: caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis; most severe and potentially life-threatening
- Viral meningitis: caused by viruses such as enteroviruses, herpesviruses, and West Nile virus; typically less severe than bacterial meningitis
- Fungal meningitis: caused by fungi such as Cryptococcus and Aspergillus; typically occurs in people with weakened immune systems
- Other types: parasitic meningitis, aseptic meningitis
Vaccination
- Available vaccines: Meningococcal conjugate vaccine (MenACWY), Meningococcal B vaccine (MenB), Pneumococcal conjugate vaccine (PCV)
- Recommended vaccination schedules:
- Meningococcal conjugate vaccine: 11-12 years old, with a booster dose at 16 years old
- Meningococcal B vaccine: 16-23 years old, with a series of 2-3 doses
- Pneumococcal conjugate vaccine: 2, 4, 6, and 12-15 months old, with a booster dose at 5 years old
Diagnosis
- Physical examination: assessing vital signs, neurological function, and overall health
- Imaging tests: CT or MRI scans to rule out other conditions
- Lumbar puncture: collecting cerebrospinal fluid to analyze for signs of infection
- Laboratory tests: blood cultures to identify the causative organism, PCR or other molecular tests to detect viral or fungal infections
Treatment Options
- Bacterial meningitis: antibiotics to treat the underlying infection, supportive care (fluid replacement, oxygen therapy, pain management)
- Viral meningitis: supportive care (fluid replacement, pain management, anti-nausea medications), antiviral medications in some cases
- Fungal meningitis: antifungal medications to treat the underlying infection, supportive care (fluid replacement, oxygen therapy, pain management)
Meningitis Signs and Symptoms
In Infants Under 2 Years
- Fever is a common symptom
- Headache may be present, although difficult to detect in infants
- Stiff neck is a characteristic sign
- Inactivity and lethargy may be observed
- Vomiting and poor feeding habits are indicative of meningitis
- Seizures may occur, which can be hard to detect in infants
In Children Over 2 Years
- High fever is a significant symptom
- Headache is a common complaint
- Stiff neck is a hallmark sign of meningitis
- Nausea and vomiting are frequent symptoms
- Sensitivity to light is a characteristic feature
- Confusion and sleepiness may be present
- Rapidly spreading petechiae is a significant symptom
- Seizures can occur in children over 2 years old
Cerebrospinal Fluid Analysis
Normal CSF
- Appearance is normal
- White Blood Cells (WBCs) count is below 5x 106/l
- Protein concentration is between 15-40mg
- Glucose level is between 45-72mg
Pyogenic Bacterial Meningitis
- CSF appearance is purulent/cloudy
- WBCs count is usually high, with many pus cells
- Protein concentration is high
- Glucose level is very low
Viral Meningitis
- CSF appearance is clear or slightly turbid
- WBCs count is raised with lymphocytes
- Protein concentration is normal or usually increased
- Glucose level is not specified (normal)
Tuberculosis Meningitis
- CSF appearance is clear or slightly turbid
- WBCs count is raised with lymphocytes
- Protein concentration is high
- Glucose level is reduced
Symptoms of Meningitis
- Common symptoms:
- Fever
- Headache
- Stiff neck
- Nausea and vomiting
- Sensitivity to light
- Confusion or disorientation
- Severe symptoms:
- Seizures
- Difficulty speaking or walking
- Weakness or numbness in the face or extremities
- Rash or skin lesions
- Newborns and infants:
- Irritability
- Refusal to eat
- High-pitched crying
- Bulging soft spot on the head
- Stiffness or floppiness
Types of Meningitis
- Bacterial meningitis:
- Caused by bacteria like Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis
- Most severe and potentially life-threatening type
- Viral meningitis:
- Caused by viruses like enteroviruses, herpesviruses, and West Nile virus
- Typically less severe than bacterial meningitis
- Fungal meningitis:
- Caused by fungi like Cryptococcus and Aspergillus
- Typically occurs in people with weakened immune systems
- Other types:
- Parasitic meningitis (caused by parasites like Naegleria fowleri)
- Aseptic meningitis (caused by non-infectious agents like medications or cancer)
Vaccination
- Available vaccines:
- Meningococcal conjugate vaccine (MenACWY)
- Meningococcal B vaccine (MenB)
- Pneumococcal conjugate vaccine (PCV)
- Recommended vaccination schedules:
- Meningococcal conjugate vaccine: 11-12 years old, with a booster dose at 16 years old
- Meningococcal B vaccine: 16-23 years old, with a series of 2-3 doses
- Pneumococcal conjugate vaccine: 2, 4, 6, and 12-15 months old, with a booster dose at 5 years old
Diagnosis
- Physical examination:
- Assessing vital signs, neurological function, and overall health
- Imaging tests:
- CT or MRI scans to rule out other conditions
- Lumbar puncture:
- Collecting cerebrospinal fluid to analyze for signs of infection
- Laboratory tests:
- Blood cultures to identify the causative organism
- PCR or other molecular tests to detect viral or fungal infections
Cerebrospinal Fluid Analysis
- Normal CSF:
- Appearance: clear
- Cells (WBCs): below 5x10^6/l
- Protein: 15-40mg
- Glucose: 45-72mg
- Pyogenic bacterial meningitis:
- Appearance: purulent/cloudy
- Cells (WBCs): many pus cells
- Protein: high
- Glucose: very low
- Viral meningitis:
- Appearance: clear/slightly turbid
- Cells (WBCs): raised lymphocytes
- Protein: normal/usually increased
- Glucose: normal
- Tuberculosis meningitis:
- Appearance: clear/slightly turbid
- Cells (WBCs): raised lymphocytes
- Protein: high
- Glucose: reduced
Treatment Options
- Bacterial meningitis:
- Antibiotics to treat the underlying infection
- Supportive care (fluid replacement, oxygen therapy, and pain management)
- Viral meningitis:
- Supportive care (fluid replacement, pain management, and anti-nausea medications)
- Antiviral medications in some cases
- Fungal meningitis:
- Antifungal medications to treat the underlying infection
- Supportive care (fluid replacement, oxygen therapy, and pain management)
Contraindications to Lumbar Puncture
- Raised intracranial pressure is suspected if:
- Glasgow Coma Scale score is less than 9, indicating reduced or fluctuating level of consciousness
- Relative bradycardia and hypertension are present
- Other signs that contraindicate lumbar puncture include:
- Focal neurological signs
- Abnormal posture or posturing
- Unequal, dilated, or poorly responsive pupils
- Papilledema
- Abnormal 'doll's eye' movements
Glasgow Coma Scale
- The Glasgow Coma Scale is a tool used to assess the level of consciousness in a person following a brain injury or other neurological condition.
- The scale ranges from 3 to 15, with 3 indicating the lowest level of responsiveness and 15 indicating normal responsiveness.
Eye Response
- A score of 1: does not open eyes.
- A score of 2: opens eyes in response to painful stimuli.
- A score of 3: opens eyes in response to voice.
- A score of 4: opens eyes spontaneously.
- A score of 5: no abnormality in eye response.
Verbal Response
- A score of 1: makes no sounds.
- A score of 2: incomprehensible sounds.
- A score of 3: utters inappropriate words.
- A score of 4: confused, disoriented.
- A score of 5: oriented, converses normally.
Motor Response
- A score of 1: makes no movements.
- A score of 2: extension to painful stimuli (decerebrate response).
- A score of 3: abnormal flexion to painful stimulus (decorticate response).
- A score of 4: flexion/Withdrawal to painful stimulus.
- A score of 5: localizes painful stimuli.
- A score of 6: obeys commands.
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Description
Assess your knowledge of Central Nervous System infections, including their causes, diagnosis, clinical presentation, and treatment. Topics covered include aetiology, pathophysiology, epidemiology, and management.
