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EMQ INTRACRANIAL INFECTIONS

1. Causes meningitis via faecal-oral transmission.

2. Transmitted through the nasal pharyngeal mucosa in children andteenagers.

3. Can infect neonates during childbirth.

4. Causes meningitis in non-vaccinated infants.

5. Causes meningitis in HIV patients.

1. A 28-yr old male is brought into A&E by his wife who says that he hasbecome increasingly confused over the past 2 days. On examination, heexhibits several neurological signs such as muscle weakness and anataxic gait. Further questioning reveals that he was recently diagnosedwith Crohns Disease and was prescribed Natalizumab.

2. An elderly man who is on dialysis for end-stage renal failure comesinto casualty complaining of a 3-day history of worsening fever,headache and diarrhoea. On examination, he is pyrexial at 39C and

displays some neck stiffness. No maculopapular rashes are observed.CSF analysis shows an abnormally low glucose level with neutrophilicinfiltrate. Several Gram-positive rods are also observed in the CSF.

3. A 52 year old man with longstanding HIV infection presents with a 2-day history of worsening 39C, headache, nausea and vomiting. Onexamination, he appears disorientated and confused and displays neckstiffness. Kernigs sign is positive. The infective organism is identified byIndian Ink examination of the CSF, which also shows reduced glucose

levels.

4. A 25 year old female presents to A&E with fever, headaches andphotophobia. On examination, she displays classical signs of meningealirritation such as neck stiffness and a positive Kernigs sign. CSFanalysis shows normal glucose and protein levels, with a lymphocyticinfiltrate observed. Further questioning revealed that she had visited herGP 1 week ago complaining of dysuria, painful vaginal discharge andgenital rashes.

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5. A 40 year old female who is undergoing treatment Human GrowthHormone replacement therapy is brought in by her husband. He saysthat she has become increasingly forgetful over the past 3 months and

that she has strange jerky movements whenever there is bright light orloud noises. Other associated symptoms include malaise andgeneralised fatigue. On examination, she appeared confused,disoriented and had an ataxic gait. The patient was noted to be afebrile.

1. A 48 year old man presents to the A&E with fever, headaches, nauseaand vomiting. History reveals chronic sinusitis. Subsequent imaging showsa ring-enhancing lesion.

2. A 16 year old boy presents with headaches, parosmia, neck rigidity,nausea and vomiting after returning from a summer holiday near LakeHoover. Diagnosis made after visualization of CSF.

3. A 36 year old woman presents to the A&E with lethargy, headaches,nausea and vomiting. CSF analysis shows neutrophils, marked increase ofproteins and low glucose.

4. A 28 year old man presents to his GP with fever, headache, lethargy and

malaise after returning from a hiking holiday in North America. Patient hasno significant past medical history. During consultation, patient becomesvery agitated when presented with a cup of water.

5. A 32 year old man presents with headaches, neck rigidity, fever andmalaise. CSF analysis shows lymphocytes, mildly elevated protein, andnormal glucose. CSF culture was negative.