Chapter 42 Flashcards
What are the differential diagnosis for fever and encephalopathy (impaired memory, hallucinations, AMS)?
CNS infections (meningitis, encephalitis and brain abscess), and sepsis
What is the diagnostic work up for this febrile encephalopathic patient?
Complete infectious work up (CBC CXR blood culture UA, urine culture) coagulation studies, BMP, CT head, lumbar puncture with CSF analysis
What is inclusive in CSF analysis?
Cell count and diff, gram stain, culture/sensitivity, bacterial antigen test, glucose, protein
What CSF are finding a suspicious for herpes encephalitis?
Pinkish fluid suggesting presence of blood;
Lymphocytic Pleocytosis, slightly elevated protein, normal glucose, RBCs do not decrease with successive tubes (1st to 4th)
What CSF order should be added if herpes encephalitis is suspected?
PCR of CSF for HSV
What is the treatment for Herpes Encephalitis?
Admit patients and institute empiric IV Acyclovir therapy (do not wait for PCR results)
What causes suspicion of herpes encephalitis?
CSF analysis
Temporal lobe abnormalities on CT/MRI
Febrile encephalopathic patient with FND
How was Herpes Encephalitis diagnosed/confirmed?
LP, CSF analysis and head CT/MRI
CSF PCR of HSV (confirms)
Acyclovir should be adjusted in what patients?
Patients with kidney failure
What should be given to patients along with Acyclovir? Why?
Hydration with normal Saline to avoid Acyclovir-induced kidney injury from crystal formation
How long should patient be treated with Acyclovir?
14 to 21 days
What are the seven different CSF test that should be ordered?
Remember order lumbar puncture first and don’t forget CSF bacterial antigen
What order should be done every time before LP?
Coagulation studies
