5.5 Meningitis, Encephalitis, Reyes Syndrome

Question 1

Hypoxic-Ischemic Brain Injury

Answer 1

• Near drowning injury
• Most common in children less than 4
• Infants in bath tubs or toddlers stuck in bodies of water (toilet bowl or big bucket)

DIAGNOSIS
- Survival occurred 24 hours after the incident
- Hypoxia that leads to brain damage (unconscious, swallowed water into lungs)

MANAGEMENT
- Monitor for at least 24 hours after the accident
- They may look totally fine but can have complications such as respiratory compromise, cerebral edema.

• KEY IS PREVENTION AND EDUCATION
• Watch children in the bathtub
• If children are around water, they are constantly being watched and have safety equipment like floaties

Question 2

Meningitis

Answer 2

• Infection/Virus of the meninges of the brain
• Can be fatal because kids decompensate and have immature immune systems
• Once bacteria reaches CNS, CSF gets filled with bacteria/infection and gets circulated throughout brain and spinal cord spreading the infection.

Symptoms
- Nuchal rigidity (Most Common)
- Fever, Irritable, Feeding Issues
- Neurocry
- Bulging Fontanels

Infants
- Seizure
- Hypothermia or Fever

Older Children
- Fever

Question 3

Diagnosing Meningitis

Answer 3

• Kernig Sign - Inability to straighten legs when hip is flexed to 90 degrees
• Brudzinski Sign - Inability to flex neck without flexing hips
• Septic Workup (Urinary analysis, CBC)
• Lumbar Puncture is the gold standard

Question 4

Meningitis Treatment

Answer 4

• ABCs
• ISOLATE CHILDREN FOR THE FIRST 24 HOURS OF ANTIBIOTIC THERAPY
• Administer antibiotics immediately after cultures are drawn (draw cultures before antibiotics) Started on broad spectrum first then specific once cultures are back
• They do not want to eat so hydration helps (iv fluids) which also helps flush antibiotics out of the body
• Seizure precautions
• Elevate HOB to reduce ICP
• Reduce external stimuli
• Dark Room and Limited Visitation

Question 5

Viral Meningitis

Answer 5

• Usually look less sick (less toxic)

Symptoms
- Fever, Irritability, Lethargy
- Not as severe as bacterial

Treatment
- Supportive care (antibiotics will not work)
- IV fluids, pain and fever management

Question 6

Encephalitis

Answer 6

• Inflammation of brain caused by a pathogen (usually viral - Varicella/MMR)

Early Signs
- Recent viral infection with fever (febrile illness) and altered mental status

Symptoms
- Severe headache
- Malaise
- N/V
- Hyperactivity
- Nuchal rigidity
- Personality changes

SEVERE SYMPTOMS
- Hallucinations
- Ataxia (affects coordination and balance)
- Seizures/Coma

DIAGNOSIS
- CT Scan for brain inflammation (usually negative at first then positive later)
- Lumbar puncture for virus in CSF fluid
- Blood draw for abnormal pathogens

Question 7

Reye’s Syndrome

Answer 7

• Acute childhood illness that causes fatty infiltration of liver, hyperammonemia, encephalopathy, increased ICP.
• Occurs from recent viral illness or aspirin administration to pediatric patients.

SIGNS
- Fever, impaired consciousness, hepatic dysfunction.
- Acute encephalopathy
- Inflammation/Cerebral Edema
- Hypoglycemia
- Enlarged non-functioning liver due to elevated ammonia (affects ALT and AST)
- Bleeding and poor coagulation due to non-functioning liver

STAGES
1 - Lethargy, vomiting, early liver dysfunction
2 - Confusion, combative, sluggish pupils, cerebral edema
3 - Seizures, coma, abnormal positioning
4 - Deeper coma, fixed pupils
5 - Respiratory Distress

MOST COMMONLY CAUSED BY ASPIRIN TO PEDIATRICS

Question 8

Diagnostic Procedures

Answer 8

Meningitis
- CSF (lumbar puncture)
- Blood culture
- Urinary Analysis

Encephalitis
- CT Scan (for inflammation)
- CSF (lumbar puncture)
- Serum Studies
- Clinical Findings

Reye’s Syndrome
- Liver Biopsy
- Clinical Findings

Question 9

Bacterial Meningitis Manifestations

Answer 9

• Malaise
• Anorexia
• Nuchal Rigidity
• Myalgia
• Skin rashes
• Positive Kernig’s Pointed Nose
• Positive Brudzinski