CNS Flashcards
Meningitis is more commonly ______ infection
bacterial
Aseptic meningitis
pathogens that don’t grow on typical bacterial media (virus, fungi, parasites, non infectious causes)
Chronic meningitis is more likely caused by…
mycobacterium or fungi
Meningitis @infants is most commonly caused by
E.coli
S.pneumonniae type B
Meningitis @children is most commonly caused by
H.influenzae & S.pneumoniae
Meningitis @young adults is most commonly caused by
N.meningitis
Meningitis @elderly is most commonly caused by
S.pneumoniae
Meningitis by Retrograde infection is transported by _______
cranial and peripheral nerves
Retrograde transport @meningitis is present @
viral illness
Common etiology of Meningitis
Otitis media
Sinusitis
CSF leak after trauma/surgery
Sepsis
What pathogen causes Neonatal meningitis
E.coli
Risk factors for meningitis infection
Crowded occupational/living conditions
Immunocompromised
Close contact with infected
Pathophysiology of Meningitis
Hematogenous
Contagious
Retrograde
Traumatic
Virulence factor of S.pneumoniae
Polysaccharide capsule
Neumolisins → pores
Virulence factor of N.meningitis
Pilis
Early and Late symptoms @Neonatal Meningitis
Early:
Lethargy
Muscle Hypotonia
Irritability
Poor apetite
Vomiting
Dyspnea
Late:
Fontalle buldging
High-pitchh cry
Seizure
T or F: In neonatal meningitis the Triad is also present
F
Meningitis Triad
Fever
Neck Stiffness
Headache
Petechial or Purpuric rash suggest…
Neisseria meningitis infection
Meningococcal
Neiseria Meningitis
WaterHouse-Friderishen Syndrome @
N.meningtis
Myalgia + Purpuric Rash suggest
Meningococcal infection
Prodrome and Flu-like symptoms followed by Neurological symptoms suggest…
Viral Meningitis
Classic Triad of Meningitis + >Sudden Onset + Lose of consciousness suggest…
Dx Diferencial → Subarachnoid hemorrhage
Clinical features @Meingismus
Triad
Altered mental tatus
Photophobia
Seizure
Nausea, Vomiting
Malaise
Cranial Nerve Palsies
Meningismus @Physical Examination
Neck Stiffness
Kernig + Brudzinski sign
→ Meningeal irritation
Fever
Hypotension
Tachycardia
→ Inflammation
Papiledema → Increased Intracraneal Pressure
Bulging+ Redness @timpanic memb. = Otitis Media
Skin manifestations ( petechiae, maculopapular rash)
→ Underlying infection
T or F: Blood culture should be taken BEFORE starting empiric antibiotics
T
Findings @CBC in Bacterial Meningitis
↑ WBC (specifically Neutrophils)
When is a Lumbar Puncture contraindicated?
Increased Intracranial Pressure
Bleeding Disorders
Local infection or lesions
What tests are preformed with the sample of CSF
CSF analysis
PCR
Gram stain
CSF analysis @Bacterial Meningitis
Cloudy/Purulent
↑ Leukocytes (PMN)
↑ Granulocytes
↑ Openning Pressure (because of edema)
↑ Protein
↑ Lactate
↓ Glucose
CSF analysis in a Viral infection
Clear
↑Lymphocytes
Normal Glucose
Where is a Lumbar Puncture preformed?
L3-L4
Empiric Tx @Meningitis
Ceftriaxone
Vancomycin
Dexamethasone (corticosteroid) = inflammation
When is Ampicillin indicated in the Empiric Tx of meningitis
@High Risk of Listeria Meningitis =
- Immunocompromised
- > 50 yo
Postexpousure Prophylaxis for close contact @Meningitis
Rifampin or Ceftriaxone
Postexpousure Prophylaxis for close contact pf Meningitis @Pregnant women
Ceftriaxone
Tx of Cyptococcal Meiningitis
Fluconazole or Amphotericin B
Viral Meningitis Tx
Acyclovir
Petechial Rashed Meningococo indicates….
Thrombocytopenia
Point of NO RETURN @Meningococo infection
16 hrs
Most common cause of Sporadic Encephalitis
HSV-1
Encephalitis is more commonly caused by ______ infections
Viral
CMV and EBV can cause Encephalitis @
Immunocompromised
Incidence of HSV infection
Bimodal
<20yo
>50yo
What type of HSV is most commonly @Neonates
1 and 2
Type(s) of HSV more common @Adults
1
How does HSV-1 spread towards the brain?
From oropharynx it spreads via Trigeminal or Olfactory nerve towards the brain
Where does HSV stay latent in the body for future reactivation?
Trigeminal ganglia
First sign of infection of HSV
Gingivistomatitis
HSV mainly affects ______ lobe causing which focal neurological effect?
Temporal
Crisis Convulsivas
T or F: Triad of Meningism is ONLY present @Meningitis
F
What part of the brain does Enterovirus infection affects
ANY part
Pathophysiology of Enterovirus Encephalitis
Viremia
“Caballo de Troya” = Macrofagos
Retrograda = Miocitos (via motora)
Focal Neurological Deficit= Ataxia
Which part of the brain is affected?
Cerebelo
Focal Neurological Deficit = Comportamiento Alterado
Which part of the brain is affected?
Frontal
Alteraciones Oftlmologicas @Encephalitis
Which part of the brain is affected?
Occipital lobe
Subacute onset of:
Psychiatric symptoms +
Seizures +
Focal Neurological Deficits
suggest….
Encephalitis
Neurological Symptoms @Encephalitis
Altered Mental Status
Memory loss
Seizures
Focal Neurological Deficit
Dysatonomia
Psychiatric symptoms @Encephalitis
Behavioral changes
Hallucinations
Anxiety
Pschosis
Dx @Encephalitis
MRI with contrast
- to look for Hyperintense temporal lobe edema @HSV
Electroencephalography
@inconclusive dx of seizures
Lumbar Puncture
Tissue Analysis
What smear is done in the tissue analysis of Encephalitis?
Tzanck Smear
= look for HSV @ suspicious skin lesions
Findings of Encephalitis @Brain Biopsy
Cowdy Type A inclusions @HSV infection
Temporal Lobe Necrosis @HSV
Tx for Enterovirus Encephalitis
Symptomatic
Tx for HSV Encephalitis
Acyclovir
Prognosis of Viral Meningitis
Resolves spontaneously
**There may be residual symptoms
Prognosis @Bacterialmeningitis
Fatal if left untreaed
Why is Ceftriazone contraindicated as Tx in Meningitis @Infants?
High risk of Kernicterus and Hiperbillirubinemia
