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
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
