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3. E Med & Surgery > 3- CNS Infections > Flashcards

3- CNS Infections Flashcards

1
Q

Causative agent of bacterial meningitis if exposure during delivery?

A

E. coli, Group B strep

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2
Q

Causative agent of bacterial meningitis if sinusitis, otitis media, mastoiditis?

A

S. pneumo

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3
Q

Causative agent of bacterial meningitis if military, college (crowded conditions)?

A

N. meningitides

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4
Q

Causative agent of bacterial meningitis if head trauma?

A

Staph spp

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5
Q

Causative agent of bacterial meningitis if post-neurosurgical procedure?

A

Staph spp, gram (-)

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6
Q

What are the 2 most common causative agents of bacterial meningitis?

A

N. meningitides (meningococcal)

S. pneumoniae (pneumococcal)

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7
Q

Pt presents with fever, nuchal rigidity, AMS, and HA +/- photophobia, N/V. On PE you note (+) jolt accentuation test. What CNS infection are you concerned for?

(jolt accentuation test - pt rotates head horizontally 2x / second, (+) = exacerbation of existing HA)

A

Bacterial meningitis

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8
Q

On PE of pt with CNS complaint, you note petechial rash and palpable purpura. What condition/ causative agent are you concerned for?

A

Bacterial meningitis; N. meningitidis

(meningococcal rash)

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9
Q

Late findings of what CNS infection include papilledema, and (+) Kernig’s and Brudzinski’s sign?

A

Bacterial meningitis

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10
Q

What diagnostics are ordered for all cases of meningitis and encephalitis?

A

Blood cultures x 2 (before abx)

LP

Labs

+/- CT

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11
Q

What is the gold standard for dx of bacterial meningitis?

A

CSF culture

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12
Q

According to the following CSF analysis, what CNS infection are you concerned about?

WBC > 1,000

Glucose < 40

CSF/ blood glucose < 0.4

Protein 200-500 (elevated)

Gram stain (+)

Neutrophils present

A

Bacterial meningitis

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13
Q

According to the following CSF analysis, what CNS infection are you concerned about?

WBC < 500

Glucose 40-80

CSF/ blood glucose 0.6

Protein 15-45

Gram stain (-)

Lymphocytes present

A

Aseptic meningitis

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14
Q

According to the following CSF analysis, what CNS infection are you concerned about?

WBC < 250

Glucose 40-80

CSF/ blood glucose 0.6

Protein- elevated < 150

Gram stain (-)

Lymphocytes present

A

Viral encephalitis

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15
Q

A CT is recommended before LP in patients with 1+ of which RFs? (6)

A
  • IMC
  • Hx of CNS disease
  • New onset seizure
  • Papilledema
  • Abn level of consciousness
  • Focal neuro deficit
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16
Q

Gram stain of pt with CNS infection shows G (+) diplococci. What is the likely pathogen?

A

Pneumococcal

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17
Q

Gram stain of pt with CNS infection shows G (-) diplococci. What is the likely pathogen?

A

Meningococcal

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18
Q

Gram stain of pt with CNS infection shows G (-) coccobacilli. What is the likely pathogen?

A

H. influenzae

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19
Q

Gram stain of pt with CNS infection shows G (+) rods and coccobacilli. What is the likely pathogen?

A

L. monocytogenes

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20
Q

What is the tx for bacterial meningitis after blood cultures and LP?

A

Dexamethasone + empiric IV abx

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21
Q

Pt with bacterial meningitis was started on dexamethasome + empiric IV abx. Gram stain or blood cultures come back (+) for S. pneumoniae (pneumococcal meningitis). What is the next step in tx?

A

Continue dexamethasone + add Rifampin

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22
Q

When do you NOT prescribe vancomycin in the tx of bacterial meningitis?

A

Newborn

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23
Q

When do you NOT prescribe ampicillin in the tx of bacterial meningitis?

A

1 month- 50 yrs

Basilar skull fracture (contiguous spread)

Penetrating trauma/ post-neurosurgery (contiguous spread)

*when you do NOT suspect L. monocytogenes*

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24
Q

When do you NOT prescribe dexamethasone in the tx of bacterial meningitis?

A

Newborn

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25
Q

How do you proceed with tx of bacterial meningitis if LP is contraindicated?

A

Continue empiric abx + dexamethasone

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26
Q

How do you proceed with tx of bacterial meningitis if no bacteria is seen on Gram stain but other CSF findings are consistent with bacterial meningitis?

A

Continue empiric abx + dexamethasone

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27
Q

DIC, ARDS, septic shock +/- impaired mental status/ cognition and sensorineural hearing loss are complications a/w what CNS infection?

A

Bacterial meningitis

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28
Q

How is bacterial meningitis prevented?

A

Vaccines

Post-exposure prophylaxis (N. meningitides)- Cipro, Rifampin, Ceftriaxone

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29
Q

What is the most common cause of aseptic meningitis?

A

Enterovirus

(HSV-2 also common)

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30
Q

Pt with recent travel hx (ticks, TB) or sexual activity (HSV-2, syphilis, HIV) is more likely to have what CNS infection?

A

Aseptic meningitis

31
Q

Pt presents with aseptic meningitis sxs + diffuse, maculopapular exanthem and is mildly ill. Suspected etiology?

A

Enteroviral infection, primary HIV, syphilis

32
Q

Pt presents with aseptic meningitis sxs + oropharyngeal thrush and cervical LAD. Suspected etiology?

A

Primary HIV

33
Q

Pt presents with aseptic meningitis sxs + asymmetric flaccid paralysis. Suspected etiology?

A

West Nile virus

34
Q

What is included in the management for aseptic meningitis?

A

Empiric abx (until r/o bacterial meningitis)

Supportive tx

Acyclovir if severe/ IMC

35
Q

Are abnormalties in brain function more common with meningitis or encephalitis?

A

Encephalitis

36
Q

What type of encephalitis is due to direct viral invasion of the CNS and has (+) neuronal involvement?

A

Primary encephalitis

37
Q

What type of encephalitis is there NO virus detected, neurons are spared, and may be a/w perivascular inflammation/ demyelination?

A

Post infectious encephalitis (acute disseminated encephalomyelitis- ADEM)

(typically occurs as initial infection is resolving)

38
Q

What is the most common cause of fatal encephalitis?

A

HSV-1

39
Q

What is the most common cause of vital encephalitis (in the US)?

A

Mosquitos/ West Nile virus

(Africa, Asia, Europe, US)

40
Q

Coxsackie, HSV-2, HIV, mumps, and measles are more commonly a/w meningitis or encephalitis?

A

Meningitis

41
Q

West Nile virus, HSV-1, CMV, and influenza are more commonly a/w meningitis or encephalitis?

A

Encephalitis

42
Q

Pt presents with HA, fever, AMS, and seizures, and on exam seems to be confused, agitated, and obtunded. Pt denies photophobia and nuchal rigidity. PE shows focal neuro deficits (hemiparesis, CN palsies, increased DTRs). What CNS infection are you concerned for?

A

Encephalitis

(photophobia and nuchal rigidity more a/w meningeal involvement so can be seen w/ meningoencephalitis)

43
Q

Pt presents with encephalitis sxs + hydrophobia, hyperactivity, and pharyngeal spasms. Suspected etiology?

A

Rabies

44
Q

Pt presents with encephalitis sxs + tremors of the tongue, lips, and eyelids. Suspected etiology?

A

St. Louis virus

45
Q

LP of pt with suspected encephalitis shows RBCs and decreased glucose in CSF. What etiology are you concerned for?

A

HSV

(RBCs = HSV-1)

46
Q

What is the dx study of choice for encephalitis?

A

MRI with contrast

47
Q

MRI with contrast of pt with suspected encephalitis shows temporal lobe changes. Suspected etiology?

A

HSV

48
Q

Pt with suspected encephalitis is not improving or no definitive dx has been made based on CSF, culture, or PCR. What should be ordered?

A

Serology

(IgM Ab testing for WNV/ mumps/ EBV)

49
Q

What dx study is ordered as a last resort and if etiology is unknown?

A

Brain bx

50
Q

What is included in management for encephalitis?

A

Empiric acyclovir (HSV most important to ID/ tx)

Seizure prophylaxis/ control

Diuretics if increased ICP- Mannitol, Furosemide

51
Q

What might indicate a worse prognosis/ poor neuro recovery in a pt with encephalitis?

A

Elevated initial ICP, intractable seizures

52
Q

What is the suspected location of cerebral abscess if hx of subacute/ chronic OM or mastoiditis?

(type of direct spread)

A

Inferior temporal lobe/ cerebellum

53
Q

What is the suspected location of cerebral abscess if hx of frontal/ ethmoid sinusitis or dental infection?

(type of direct spread)

A

Frontal lobes

54
Q

What is the primary source of hematogeneous spread causing cerebral abscess?

A

Bacterial

55
Q

Suspected etiology of cerebral abscess if immigrant from Mexico?

A

Parasite

(Cysticercosis, Taenia solium)

56
Q

Fungal pathogens as the cause of a cerebral abscess is a/w what?

A

Multiple abscesses, poor outcomes

57
Q

Pt presents with unilateral, severe HA that is not relieved with OTC pain meds +/- fever and focal neuro deficits. What you concerned for?

A

Cerebral abscess

58
Q

What is the imaging study of choice for cerebral abscess?

A

MRI with contrast

59
Q

MRI w/ contrast of pt with suspected CNS infection shows a ring-enhancing lesion that is poorly demarcated with localized edema, acute inflammation and no evidence of tissue necrosis. What are you concerned for?

A

Early cerebral abscess

(1-2 weeks)

60
Q

MRI w/ contrast of pt with suspected CNS infection shows a ring-enhancing lesion with necrosis and liquefaction, and is surrounded by a fibrotic capsule. What are you concerned for?

A

Late cerebral abscess

(> 2 weeks)

61
Q

In pt with suspected cerebral abscess and focal sxs, unilateral CN deficits, or hemiparesis/ papilledema, what study is contraindicated?

A

LP

62
Q

What is the management for cerebral abscess?

A

Neurosurgery involvement (CT-guided aspiration/ surgical excision)

Empiric IV abx (then alter once pathogen established)

63
Q

What is the tx for cerebral abscess if oral source?

A

Metro + penG

64
Q

What is the tx for cerebral abscess if otogenic or sinus source?

A

Metro + ceftriaxone or cefotaxime

65
Q

Intracranial epidural abscess (IEA) is typically a complication of what?

A

Neurosurgery

66
Q

Pt presents with fever, HA, lethargy, N/V +/- purulent drainage from nose/ ear (secondary to sinusitis) OR +/- increased ICP/ papilledema, focal neuro changes (brain compression). What are you suscpicious for?

A

IEA

67
Q

What is the dx study of choice of IEA?

A

MRI w/ contrast

68
Q

What is the management for IEA if post- neurosurgery?

A

Drainage + abx

Neurosurgery involvement

Repeat MRI in 4-6 weeks

69
Q

What is the management for IEA?

A

Empirix abx

If contiguous spread: Metro + 3rd gen Cef

All others: Vanco + Metro + 3rd gen Cef

70
Q

Direct extension of osteomyelitis, direct inoculation into spinal canal (epidural catheter) hematogenous spread of bacteria, damage to spinal cord, or microbes (S. aureus) can all result in what CNS infection?

A

Spinal epidural abscess (SEA)

71
Q

Pt presents with fever, spinal pain, neuro deficits +/- back pain, shooting/ “electrical” nerve root pain, motor weakness/ sensory changes/ B+B dysfunction, or paralysis. What are you concerned for?

A

SEA

72
Q

What is the most concerning complication a/w SEA?

A

Irreversible paraplegia

(24- 36 hours)

73
Q

What is 1st and 2nd line dx imaging of choice for SEA?

A

1st line- MRI w/ contrast asap

2nd line- CT w/ contrast

74
Q

What is the management for SEA?

A

Vanco + 3rd/ 4th gen Cef x 4-8 weeks

Early surgical decompression/ drainage

F/u MRI in 4-6 weeks

3. E Med & Surgery (19 decks)

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