Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro 2 (Mo) > Acute CNS Infections/Infectious Diseases > Flashcards

Acute CNS Infections/Infectious Diseases Flashcards

1
Q

clinical presentation, most common organisms for different age groups

A

x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

basic CSF profile (cell number and type, glucose, protein) for bacterial meningitis

A

x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

basic medical management for bacterial meningitis in different age groups

A

x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

the clinical features, most common viruses, basic CSF profile, and key diagnostic tests for viral meningitis and viral encephalitis

A

x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

basic clinical features, diagnostic tests, and initial antimicrobial therapy for patients with a focal suppurative CNS infection (e.g., brain abscess, empyema)

A

x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Viral Infections of the CNS

A

Viral Meningitis

Viral Encephalitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_________ is an infection of the subarachnoid space (SAS)

A

Meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Inflammation in SAS

A 
Increases BBB Permeability
Vasogenic edema & Increased ICP
Causes infarction from vasculitis
Interferes with CSF Circulation
Hydrocephalus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bacteria induce_____________

TNF-a, IL-1: Recruit PMNs, Reactive Oxygen Species add to vasogenic, cytotoxic edema

A

pro-inflammatory cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Bacterial MeningitisClinical Features

Classic Triad

A

Stiff Neck (Nuchal Rigidity)
Fever
Depressed Consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bacterial MeningitisClinical Features, other

A 
Headache
Other CNS Findings
Seizures
CN Palsies (III, VI, VII, VIII)
Focal Deficits (Hemiparesis, Gaze Pref., Ataxia)
Papilloedema in
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Meningeal Signs

A

Kernig’s sign, Brudzinski’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Kernig’s sign

A

supine patient, flex thigh to abdomen. Passive extension of leg, patient resists due to pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Brudzinski’s sign

A

passive flexion of neck causes flexion of the hips & knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lumbar Puncture Results Bacterial Meningitis

A 
CSF pleocytosis 1000-5000/mm3 
Percentage neutrophils/PMNs ≥80%
Protein 100-500 mg/dL
Glucose ≤40 mg/dL
CSF-to serum glucose ratio ≤0.4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do you need prior to LP

A

Should have CT or MRI prior to lumbar puncture

Pts w/ ams, ↑ ICP signs, new sz (prevent herniation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Neonatal

A

Group B streptococcus (GBS)- 50%
Escherichia coli (E. coli)- 14%
Streptococcus pneumoniae (pneumococcus)- 9%
Neisseria meningitidis (meningococcus)-8%
Listeria monocytogenes- 4% and only in 1st 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bacterial MeningitisMicrobiology: 2-23months

A 
Group B Strep (Strep. agalactiae)
E. coli 
H. influenzae
Strep. pneumoniae
Neisseria meningitidis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

2-35yrs

`Bacterial MeningitisMicrobiology

A 
Neisseria meningitidis (‘Meningococcus’) 50-60 %
Streptococcus pneumoniae (‘pneumococcus’) -25-30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

> 35yrs

Bacterial Meningitis Microbiology

A

Streptococcus pneumoniae -50-70%
Neisseria meningitidis -10-25%
Listeria monocytogenes -5-10%
10-15% if >60 yrs

21
Q

Corticosteroid Recommendations- Bacterial Meningitis

A

Start Corticosteroid Therapy with or prior to 1st dose of antibiotics.

Continue therapy if pneumococcus identified.

Caution using corticosteroids in immune suppressed or individuals from non-industrialized, developing regions.

22
Q

Bacterial Meningitis and ICP

A

Patients with signs of increased ICP may benefit from insertion of an ICP-monitoring device.*

ICP > 20mmHg (~25cmH20) should be treated.

Appropriate treatment for increased ICP in bacterial meningitis is not known.

23
Q

Bacterial meningitis is a medical emergency and __________ should be started within 1 hour of entering the hospital or clinic.

A

empiric antibiotic therapy

24
Q

The ____________ determine the most likely causative organism and guide empiric therapy

A

age of the patient, CSF profile, and epidemiologic risks

25
Q

Imaging to evaluate for a CNS mass should not delay:

A

initiation of empiric antibiotic therapy.

26
Q

__________ in patients with bacterial meningitis may prevent hearing loss and improve outcomes in developed countries

A

Corticosteroids

27
Q

Viral Meningitis & Encephalitis s/s

A

Significantly Altered Mental Status, Focal Neurological Deficits, seizures all suggest brain parenchymal involvement (Encephalitis, Abscess/Empyema, etc.)

28
Q

Viral Meningitis organism

A

Enteroviruses

HSV-2

29
Q

Viral Encephalitis organism

A

WNV (west nile)

HSV-1

30
Q

Viral CNS InfectionCSF Profile

A

Lymphocytic Pleocytosis
PMNs early in some (Repeat LP @24 hrs)
Normal Glucose
Normal or mildly elevated protein
PCR positive (Enterovirus, HSV, CMV, EBV, VZV)
CSF Serology (IgM) for WNV and other arboviruses

31
Q

Enteroviruses

A

Most common cause viral meningitis
Fecal-oral transmission (Occ. Respiratory)
Late Summer/early Fall Prevalence

32
Q

Enterovirus Clues

A

Rash, Pharyngitis/Herpangina, GI, Pleurodynia, Myocarditis, Pericarditis, Conjunctivitis

33
Q

Autoimmune Encephalitis

A

Anti-NMDA Receptor Encephalitis:

CSF profile looks like viral encephalitis

34
Q

Goal is to start Antibiotics within_____ of patient arrival in the emergency room

A

60 minutes

35
Q

ampicillin PLUS cefotaxime OR ampicillin PLUS aminoglycoside

A

Neonates:

36
Q

Ceftriaxone AND Vancomycin

A

Children (>2mo)/Adults

37
Q

Ceftriaxone AND Vancomycin AND Ampicillin

A

Adults >50

38
Q

Meropenem or Cefepime AND Vancomycin +/- Ampicillin

A

Immunocompromised/Nosocomial/Recent Head trauma/Neurosurgery

39
Q

Arboviruses

A

WNV

40
Q

WNV Human Infection “Iceberg”

A

10% fatal
20% fever
80% asymp

41
Q

WNV Meningoencephalitis

A 
Fever, Headache, Nuchal Rigidity
Nausea, Vomiting, Neck Pain, Myalgia 
Low Back Pain
Tremor
Parkinsonism-rigidity, bradykinesia, instability
Myoclonus, opsoclonus-myoclonus
Weakness: Flaccid paralysis
Cranial Nerve Palsy (esp. facial weakness) 
Cerebellar Signs
42
Q

WNV Neuroimaging

A

Early: MRI often completely NORMAL
Later: ~30% Abnormalities in deep gray nuclei
Subtle, symmetric findings
Most similar to JEV and SLE
Thalamus, Basal Ganglia, Midbrain (Nigra), Brainstem
Unlike HSV, HHV-6 : “Limbic encephalitis”
Medial Temporal Lobe and Hippocampus

43
Q

CSF in WNV

A

Pleocytosis up to >2000 cells (mean ~250)
PMNs can predominate & persist (4-7d)
Reactive Lymphocytes (“plasma cells”, “Mollaret”)
Elevated protein (50-250 mg/dL)
Normal glucose
WNV IgM diagnostic (does not cross BBB)
+PCR diagnostic (sensitivity ~70%)

44
Q

_______ is the most common cause of sporadic encephalitis and West Nile virus is the most common cause of epidemic encephalitis in the US.

A

Herpes Simplex virus

45
Q

CSF PCR is a sensitive diagnostic tool for Herpes infections and ______ is the diagnostic test of choice for neuroinvasive West Nile virus.

A

CSF IgM

46
Q

Start empiric ________ in patients with suspected encephalitis as soon as possible

A

acyclovir

47
Q

Adult Clinical Evaluation Summary

Clinical Meningitis

A

Blood cultures + empiric treatment for bacteria +/- antiviral for HSVII
LP: Viral (aseptic) or Bacterial CSF Profile
May obtain imaging prior if indicated but often negative
If viral: likely causes enterovirus, HSVII, WNV, VZV, etc.

48
Q

Adult Clinical Evaluation Summary

Possible Encephalitis

A

MRI: mass lesion or other cause of brain parenchymal involvement?
LP: Viral or bacterial CSF Profile
Empiric antiviral for HSVI +/- antibiotics (concern for severe meningitis start antibiotic 1st as per meningitis!!!)

49
Q

Herpes Simplex virus is the most common cause of sporadic encephalitis and _______ is the most common cause of epidemic encephalitis in the US.

A

West Nile virus

Neuro 2 (Mo) (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions