Chronic Meningitis Brain Abscess

Question 1

Chronic meningitis is suspected when characteristic s/sx are present for how many weeks?

Answer 1

4 weeks

With persistent wbc > 5/ul

Question 2

What are the cardinal features of chronic meningitis?

Answer 2

Persistent headache, hydrocephalus, cranial neuropathies, radiculopathies, cognitive and personality changes

Question 3

This is a non - encapsulated brain abscess.

Answer 3

Cerebritits

Question 4

In immuno-compitent individuals, this is the most common pathogen?

Answer 4

Streptococcus species - 40%

Other common causes of brain abscess include:
Enterobacteriaceae - 25%
Anaerobes - 30%
Staphy - 10%

Question 5

For immuno - deificient individuals what organisms are usually found?

Answer 5

Candida
Nocardia
Neoformans
Toxoplasma gondii
Aspergillus

Question 6

Modes a brain abscess may develop?

Answer 6

Direct
Hematogenous
After trauma or head surgery

Question 7

Approximately 1/3 of brain abscess is associated with this condition?

Answer 7

Otitis media

Question 8

Common sites of otogenic brain abscess?

Answer 8

Temporal lobe and cerebellum

Question 9

Most common pathogens associated with paranasal sinusitis?

Answer 9

Strep
Hemophilus spp
Bacteroides spp
Pseudomonas spp
Staphy spp

Question 10

Characteristics of brain abscess due to hematogenous spread

Answer 10

Multiple locations

Pedicliction to the teritory of the MCA

Question 11

What is the typical presentation of patients with brain abscess?

Answer 11

Expanding mass rather than an infection

Question 12

Most patients with brain abscess prsents after how many days?

Answer 12

11-12 days

Question 13

Classic clinical triad of brain abscess

Answer 13

Headache
Fever
Focal neurologic findings

Occurs in only <50% of patients

Question 14

The most comon presentation in patients with brain abscess?

Answer 14

Headache

> 75% of patients present with headache

Question 15

Most common sign of patient with frontal lobe abscess?

Answer 15

Hemiparesis

Question 16

Patients with cerebellar abscess presents with what clinical finding?

Answer 16

Signs of increased ICP

Question 17

What is the diagnostic modality for patients with brain abscess?

Answer 17

Neuroimaging

Question 18

On contrast enhanced CT what is the appearance of a mature abscess

Answer 18

focal area of hypodensity surrounded by a rim enhancement with surrpounding edema

Question 19

What is the method to differentiate an absecess from an intracranial mass?

Answer 19

Diffusion-weighted imaging

• increased signal due to restricted diffusion of a brain abscess

Question 20

What is the role of LP in patients with brain abscess?

Answer 20

Nothing

** LP contributes nothing to the diagnosis of BA

Question 21

Emperical treatment of immunocompitent patients with Brain Abscess includes?

Answer 21

3rd or 4th gen cephalo + metrinidazole

Question 22

This antibiotic is added to patients with suspected pseudomonas spp

Answer 22

Ceftazidime

**Vancomycin for suspected staph

Question 23

Medical therapy alone is not sufficient to treat brain abscess however in certain cases this is the only option. What are those cases?

Answer 23

Small < 2-3 cm

Non-encapsulated

Surgery is complicated and risky

Question 24

What is the role of anticonvulsants in brain abscess

Answer 24

Included in the 3A management of brain abscess

Aspiration
Antibiotics
Anticonvulsant

** anticonvulsant usally given at least 3 months after resolution of abscess

Question 25

Glucocorticoids are not part of the mgt of brain abscess unless with signs of increasing icp

True or false?

Answer 25

True

Question 26

Minumum duration of antibiotic treatment for brain abscess

Answer 26

6-8 weeks