04.04 Neuro

04.04 Neuro [PDF link]: Bacterial & viral meningitis – Kernig’s sign, Brudzinski’s sign, Encephalitis – Herpes simplex encephalitis, Brain abscess, Spinal epidural abscesses

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Meningococcal disease

• Refers specifically to meningococcal sepsis (caused by Neisseria meningitidis) with or without meningococcal meningitis.

• S/smx more specific to meningococcal disease include

  • Haemorrhagic rash, with lesions ≥2mm (purpura)

  • Rapidly progressive

  • Above in combination with s/smx of bacterial meningitis

    • Red flag combination: fever, headache, neck stiffness, altered level of consciousness / altered cognition / changed behaviour

    • Non-blanching rash can also occur in only bacterial meningitis (either purpuric or petechial)

• Increased suspicion in patients with the following risk factors

  • Reduced or absent spleen function (reduced ability to clear encapsulated organisms like N meningitidis)

  • Complement deficiency (again related to decreased ability to clear encapsulated organisms)

  • Student in university, close contact of other people who have had similar illness, recent outbreak of meningitis (spread)

• Treatment for suspected/confirmed meningococcal disease

  • Same as bacterial meningitis: ceftriaxone first line, if delay in reaching hospital, give IM/IM benzylpenicillin

  • If pen-allergy, second line options include co-trimoxazole or chloramphenicol