Acute Illness: Neuro Flashcards
Herpes Zoster (Shingles)
Is a reactivation of the viral infection common in childhood known as chickenpox. The virus is contagious for those who have not had the chickenpox or who have not been vaccinated.
Varicella-zoster virus is stimulated and produces a blister-like rash, commonly seen on the chest and trunk area. This rash is commonly confined to one side of the body.
Herpes Zoster (Shingles) prevention
Zostavax is a vaccination for the prevention of shingles. The CDC recommends this onetime vaccine for anyone age 60 and older.
Treatment plan for Herpes Zoster (Shingles)
A. Shingrix two dose vaccine, but dose not treat active shingles.
B. The shingles rash usually lasts 2 to 3 weeks; however, symptoms may persist beyond this period.
C. The goal is to relieve the itching.
D. Apply warm soaks of Burow’s solution three times a day to lesions.
E. Notify family and friends of active virus. Advise anyone who has had contact with you that you have shingles, especially pregnant women and those who have never had the chickenpox.
ACTIVITY: avoid touching the shingles. Wash your hands. Your partners should not touch the area, especially when blisters are present. Use separate bath towels.
DIET: There is no special diet for shingles.
MEDICATIONS:
Oral and topical medications may be prescribed to soothe the itching. Take acetaminophen as needed for comfort. Antiviral medications are available to help slow down the virus if started within 48 to 72 hours after the initial outbreak. You may be prescribed medications to help with the painful sensations.
CDC RECOMMENDS ALL IMMUNOCOMPETENT ADULTS AGE 50 years of age and older receive the Shingrix vaccine.
Postherpetic neuralgia treatment
PHN occurs in 15%of patients-commonly in elderly
- most debilitating aspect
- burning, throbbing, aching
- results in chronic fatigue, sleep disorder, depression, anorexia, disrupts IADLs/ADLs
- effects last weeks to indefinitely
PHN treatment:
- anticonvulsants: Gabapentin 100-600mg three times a day or pregabalin
- tricyclic antidepressants: amitryptylline 25 mg at bedtime or other low-dose antidepressants (fluoxetine and Effexor safer for elderly population)
- alternatives: lidocaine may provide short-term relief: opioids with caution if other options fail.
Meningitis
An inflammation of the meninges, the 3 layers of membrane enclosing the brain and spinal cord. Viral or bacterial infections are the most common causes of meninges inflammation.
Bacterial meningitis
Caused by pyogenic inflammation of the meninges and subarachnoid cerebrospinal fluid. If the infection is left untreated, it can lead to death or lifelong disabilities. There are 2 categories of infections involving the CNS: one involves the meninges (meningitis)and the other the parenchyma (encephalitis)
It is a severe infection with associated complications including brain damage, hearing loss, neurologic/learning disabilities, and digit or limb amputations. Mortality rate varies in part to the organism and if it is nosocomial or a community-acquired infection.
Viral meningitis
In most cases, 85%, is benign, self limiting and may only need supportive care. But I’m some instances, an antiviral may be indicated. Causes of meningitis can include viruses, bacteria, fungi, drugs and parasites.
Viral is the most common form of meningitis.
- enterovirus category: coxsackievirus A, coxsackievirus B and echo viruses
- west Nile, influenza, mumps, measles, herpes, HIV, Coltivirus (Colorado tick fever), and lymphocytic choriomeningitis virus.
Etiology of bacterial meningitis
Streptococcus pnuemoniae, Neisseria meningitidis, Haemophilus influenza, Listeria monocytogenes, and group B streptococcus
Fungal meningitis
Most common fungi: cryptococcus (most common form of meningitis in people with HIV or cancer), Histoplasma, Blastomyces, Coccidioides
Noninfectious meningitis causes:
Cancers
Systemic Lupus Erythematous-often precipitated by drugs
Drug-induced meningitis includes NSAIDs, corticosteroids, anti microbial, muromonab, IV immunoglobulin, TNF-alpha inhibitors, Solitis, and drugs and diagnostic agents administered intraventicularly and intrathecally
Neurosurgery and deep brain stimulation hardware
Meningitis noninfectious insult:
Head trauma, such as a bleed in the subarachnoid space , causes aseptic meningitis. Three baseline clinical features have been independently associated with an adverse outcome-hypotension, altered mental status, and seizures
Meningitis risk factors:
Poverty
Lack of childhood immunizations
Crowded living conditions
College students and soldiers
Day care attendance
Immunodeficiency (sickle cell, asplenia, Hodgkin’s disease)
Infectious disease close to meninges: pneumonia, pharyngitis, otitis media, sinusitis, endocarditis, tooth infection
Penetrating head or spinal cord trauma, spinal tap or spinal surgery
Syphillis infection
Lyme disease
Microbiologists routinely working with isolates of N. Meningitis
Outbreaks within community
Meningitis incidence:
- children: less than 1 year at risk
- Peak Incidence: adolescents/young adults ages 16-23(e.g., freshman college students living in dorms)
- Adults: greater than age 60 risk rises again
Meningitis diagnostic testing-lumbar puncture
Viral
- some lymphocytes
- normal glucose
- moderately high protein
- normal or moderately elevated opening pressure
Bacterial
- increased lymphocytes
- decreased glucose
- high protein count
- markedly elevated opening pressure
Differential diagnosis:meningitis
Bacterial vs viral meningitis Aseptic meningitis Encephalitis (herpes/rabies) Brain abscess Noninfectious meningeal irritation (sarcoidosis, chemical irritants, medications, cancer, SLE) Bacterial sinusitis Vertebral osteomyelitis Amebic meningitis Dental abscess Lyme disease Dementia
