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Senior - ID 3 > 19 - Encephalitis And Meningitis > Flashcards

19 - Encephalitis And Meningitis Flashcards

1
Q

Encephalitis

A

Inflammation of the brain

- usually viral

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2
Q

What is a bacterial brain infection?

A

Cerebritis

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3
Q

Primary vs secondary encephalitis

A

Primary: virus invades brain and spinal cord

Secondary: (post infectious) encephalitis

  • virus infects another part of the body
  • secondarily enters the brain
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4
Q

Short list of common encephalitis viruses?

A

Herpes

  • HSV
  • VZV

Childhood
- MMR

Arboviruses
Rabies
Toxoplasmosis

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5
Q

Herpes encephalitis spread by?

A

Reactivation

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6
Q

Arbovirus is spread by?

A

Mosquitos

Ticks

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7
Q

Rabies

A

Infected animal

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8
Q

VZV Cytomegalovirus are more common in?

A

Immunocompromised

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9
Q

Pathophysiology of encephalitis?

A

Crosses the BBB

  • virus enters neural cells
  • disruption in cell functioning
  • perivascular congestion
  • hemorrhage
  • inflammatory response
  • diffusely affects gray matter
  • focal or diffuse pathology
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10
Q

S/s of encephalitis?

A

Focal and diffuse presentation

  • fever w HA
  • N/V
  • behavioral changes
  • decreased LOC
  • stiff neck
  • photophobia
  • lethargy
  • gen/local seizures
  • acute confusion
  • amnestic states
  • flaccid paralysis
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11
Q

Physical signs of encephalitis

A 
Altered mental
Focal 
- hemiparesis
- focal seizures
- autonomic dysfunction
Movement disorders
Ataxia
Cranial nerve defects
Dysphagia
Meningismus
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12
Q

MC physical finding for encephalitis?

A

Altered mental status and or personality changes

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13
Q

Diagnostics for encephalitis?

A 
Head CT
- w and w/o contrast
- before LP
MRI 
- most likely to show abnormals
Electroencephalography
CSF
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14
Q

Which diagnostics are required?

A

Must do a CT first

  • elevated ICP
  • obstructive hydrocephalus
  • mass effect

Then must do LP
- CSF analysis

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15
Q

Tx for encephalitis?

A

Supportive

  • airway
  • fluids/electrolytes
  • nutrition
  • secondary infection
  • hyperpyrexia
  • manage ICP
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16
Q

How do you manage ICP?

A

Head elevation
Diuresis
Mannitol
Seizures

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17
Q

HSE is MC where?

A

Herpes eimplex encephalitis is MC in western countries

- still rare

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18
Q

What causes HSE?

A

Reactivation of HSV

  • lying dormant in the trigemianal ganglia
  • acute onset of sever symptoms
  • NOT associated with active diseases (cold sores)
  • CNS spread from HSV spread through the olfactory tracts
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19
Q

Mortality rate for HSE?

A

50-75%

But 100% have long-term motor and mental disabilities

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20
Q

HSE s/s?

A

Psychiatric symptoms
Anterior opercular syndrome
Global aphasia

Disease specific

  • HSV-1 - brainsetm encephlitis
  • HSV-2 - myelitis
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21
Q

What is anterior opercular syndrome?

A

Benign recurrent meningitis

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22
Q

Diagnostic studies from HSE?

A

PCR DNA for HSV
CT scan
- low density

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23
Q

HSE tx?

A

Supportive

Acyclovir (zovirax)

Can actually treat this one!!

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24
Q

Arbovirus means?

A

Arthropod-borne virus

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25
Q

Arboviruses require?

A

Vector

  • mosquito
  • tick (rare)

Birds infect the mosquitos

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26
Q

Common symptoms of arboviruses?

A

Usually few or no symptoms

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27
Q

2 MC arboviruses?

A

St louis encephalitis
- urban near Mississippi river

California virus
- N midewst and East

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28
Q

Less common arboviruses?

A

Eastern equine encephalitis (EEE)

  • rare but high mortality
  • found in new england

Western equine encephalitis (WEE)
- rural communities west of Mississippi river

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29
Q

S/S of arboviruses?

A 
- Mimics encephalitis
Vary by virus 
- Dysuria/pyuria
- Seizures
- Movement disorders
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30
Q

Dysuria and pyuria occur in?

A

St. Louis encephalitis

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31
Q

Generalized or localized seizures occur with?

A

California encephalitis

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32
Q

Movement disorders are common in?

A

St. Louis encephalitis
EEE
WEE

  • Eastern equine encephalitis
  • Western equine encephalitis
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33
Q

Labs/diagnostics for arboviruses?

A

Leukocytosis

EEG changes

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34
Q

Tx for encephalitis

A

Supportive

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35
Q

Preventative for encephalitis?

A

Insect repellant

  • Skin
  • Homes

No water-holding containers around the home

36
Q

West nile is a?

A

Arboviral - flavivirus

37
Q

Transmission of west nile?

A

Birds
Mosquitos

Throughout the US
Mostly summer/fall but year round in the south

38
Q

Old people are at an increased risk for (west nile)

A

Neuroinvasive infection

39
Q

S/s of west nile?

A
  • Mild/asymptomatic (vast majority)
  • encephalitis
  • lethargy (extreme)
  • flaccid paralysis
40
Q

Flaccid paralysis with WNE?

A

Only 10% of the time

41
Q

Diagnostics for WNE?

A

Leukopenia

Serologic testing

42
Q

Tx for WNE?

A

Supportive

43
Q

Major pathways for meningitis?

A
  1. Invasion of the bloodstream
  2. Retrograde neuronal pathway
  3. Direct contagious spread
44
Q

How does meningitis direct contiguous spread work?

A

Spreads to brain from

  • Sinusitis
  • Otitis media
45
Q

Before HIB vaccine most bacterial meningitis included

  • H. flu,
  • N. Meningitis,
  • S. Pneumoniae

Now its usually?

A

Its a disease of adults

- penicillin-resistant S. pneumonia

46
Q

The HIB vaccine…

A

Decreased HIB meningitis by 90%

- got to be alive to have autism, just saying

47
Q

Classic presentation of meningitis?

A 
Fever 
Ha
Neck stiffness
Photophobia
N/V
Papilledema
Rash
Hepatosplenomegaly
Cerebral dysfunction
48
Q

Meningitis cerebral dysfunction symptoms?

A

Lethargy
Confusion
Coma

49
Q

Triad of meningitis?

A

Only 2/3 of pts

  • Fever
  • nuchal rigidity
  • mental status change
50
Q

Kernig sign?

A

Hip at 90*
Cant extend Knee
- hamstring pain

Indicates meningeal irritation

51
Q

Brudzinski sign?

A

Chin Bent to chest

Hips flexion

52
Q

Atypical presentation of meningitis?

A

HIV
Elderly
- May be subtle
- May be mostly lethargy

Neutropenia pt’s
- subtle symptoms of meningeal irritation

53
Q

Cornerstone for meningitis diagnosis?

A

CSF

54
Q

Meningitis CT/MRI

?

A

DO NOT aid in diagnosis of meningitis

55
Q

CSF finding chart?

A

Youve seen it before, its on slide 33

56
Q

MC bacterial meningitis pathogens?

A

S. Pneumonia
N. Meningitidis
H. Influenzae

57
Q

MC meningitis in neonates?

A

GBS
E. Coli
Listeria monocytogenes

58
Q

MC bacterial meningitis in US?

A

Streptococcus pneumonia

59
Q

Tx for s. Pneumoniae meningitis?

A

Cefotaximine
Or
Ceftriaxone

And
Vancomycin + dexamethasone

60
Q

S. Pneumonia findings on CSF?

A

Fulminant illness with
CSF
- PMNs > 1000
- low glucose (<25%)

61
Q

Neisseria meningitis is a?

A

Gram-neg diplococcus

Seen in epidemics

62
Q

N. Meningitis risk?

A

High mortality

High risk in

  • asplenics
  • Terminal complement deficiency
63
Q

Tx for M. Meningitidis?

A

Cefotaximine /Ceftriaxone
+
Vancomycin + dexamethasone

64
Q

N. Meningitis is found in?

A

Africa
College students (dorms)
Military recruits

65
Q

Prevention for N. Meningitis?

A

Vaccine for:

  • asplenic pts
  • HIV
  • college students
  • recruits
  • the Hajj
66
Q

The N. Meningitis vaccine is?

A

New tetravalent conjugate vaccine

- recommended for young adolescents

67
Q

listeria monocytogenes is common in?

A

Setting of cell-mediated immune deficiency

Rare in healthy adults

  • age >50
  • pregnancy
  • alcoholics
  • steroids
68
Q

Tx for listeria monocytogenes?

A

Ampicillin + gentamicin

  • empiric abx
  • pending CSF results

Droplet isolation x 24-48hrs

69
Q

Who needs Post exposure prophylaxis for N. Meningitidis?

A

Close contacts

  • prolonged contact >8hrs
  • close proximity <3 feet
  • directly exposed to secretions
  • w/in 1 week before onset of symptoms

Medical personnel - airwary

70
Q

Prophylaxis meds for N. Meningitis?

A

Ceftrixone - 250mg
Or
Rifampin 600mg

Cipro 500mg

71
Q

The big menigitis bugs?

A

Viral

  • enterovirus (coxsackie)
  • herpesvirus
  • arthropod-borne
  • HIV

Parasitic
- free living amoebas

Fungal

  • C. Neoformans
  • C. Immitis
  • B. Dermatidis
  • candida
  • H. Capsulatum

Special

  • TP
  • syphilis
72
Q

Tx of viral mengitis?

A

Only require supportive care
- self limited

Antivirals may be used if needed

73
Q

Fungal meningitis tx?

A

Antifungals as needed

74
Q

TB meningitis tx?

A

Isoniazid (INH)

Pyrazinaminde (PZA)

75
Q

Syphilitic meningitis tx?

A

Aqueous crystalline Pen G

Benzathine Pen G

76
Q

Differential for meningitis?

A 
Brain abscess
Noninfectious meningitis
Meningeal carcinomatosis
CNS vasculitis
Stroke
77
Q

What is a prion-related disease

A

Proteinaceous infectous particles

- affects humans and animals (humans are animals… just saying)

78
Q

Examples of prion-related diseases?

A

Kuru
Creutzfeld-jakob diease
Bovine spongiform encephalopathy

79
Q

Prion related diseases fun facts?

A

Strangely unique
- inheritied/ sporadically/ infectious

Long incubation periods

80
Q

Prion disease tx and mortality?

A

All are fatal

No treatment

81
Q

S/s of prion-related diseases?

A
  • 6-7th decade of life
  • Dementia (progresses)
  • Multifocal neurological dysfunction
  • myoclonic fasciculations
  • ataxia
  • somnolence
  • progressive cognitive impairment
82
Q

Diagnosis of prion-related diseases?

A

Lab - developing PCR
MRI - bilateral areas of increased intensity
CSF - increased protein (CSF)

83
Q

Infections tissue with prion-related diseases

A

Brain/eye tissue
Cerebral electrodes
Infected instruments

84
Q

Prion-related diseases medical equipment?

A

Special autoclaving and treatment for known cases

85
Q

Differential for prion-related diseases?

A
  • Alzheimer disease
  • Dementia in motor neuron disease
  • HIV-1 encephalopathy
  • AIDS dementia complex
  • herpes simplex encephalitis
  • hydrocephalus
  • inherited metabolic diseases
  • multiinfarct dementia
86
Q

I dont care what people think of me

A

At least mosquitos find me attractive

Senior - ID 3 (11 decks)

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