CNS Flashcards
The most common form of suppurative CNS infection
Bacterial meningitis
Cause recurring epidemics of meningitis
N meningitidis
90% of patients with meningitis will have opening pressure CSF of
> 180
Most common. Cause of meningitis adults > 20
S pneumoniae
Abx used in the empirical therapy bacterial meningitis
Cefotaxime or Ceftriaxone or cefepime + vancomycin
Role of dexamethasone in meningitis
Dec CSF outflow resistance
Inhibits TNFa and IL1B
Rationale for giving dexamethasone prior to antibiotic therapy
It exerts production of TNFa by macrophages and microclimate only b fore the cells are activated by endotoxins
Most likely agents in viral meningitis
Enteroviruses
Causes of subacute meningitis
MTb C neoformNs T pallid in H capsulatum C immitis
CSF abnormalities in fungal infection
Mono or lymphocytic oleo cytosine
Increased protein concentration
Decreased glucose concentration
Rx tuberculous meningitis
hRZE and pyridoxine
Treat 10 months
Multifocal areas of demyelination of varying size sparing spinal cord and optic nerves
PML
Most common localizing sign of frontal lobe abscess
Hemiparesis
Classic triad of abscess
Found in <50%
Fever headache
FND
The most common parasitic disease of the CNS
Neurocysticercosis
Treatment CST toxoplasmosis
Sulfadiazine
Pyrimethamine
MC predisposing condition to subdural empyema
Sinusitis
FRONTAL SINUS!!!
Classic CSF abnormalities in Tb meningitis
Elev opening pressure
Lymphocytic pleocytosis
Elevated protein concentration
Decreased glucose concentration
Combination that is HIGHLY SUSPICIOUS for TB meningitis
Stiff neck Fatigue Night defeats Fever CSF lymphocytic pleocytosis Mildly decreased glucose concentration is highly suspicious for TB meningiti
Phases of brain abscess formation
Early cerebritis
Late cerebritis
Early capsule formation
Late capsule formation
Empiric therapy of brain abscess
3rd or 4th generation cephalosporin and metronidazole
Until when should patient with brain abscess receive seizure prophylaxis?
3 months after the resolution of the abscess
Most common symptom in patients with brain abscess
Headache
Rx for progressive multifocal leukoencephalopathy
Mirtazipine 15 mg/tab OD
Treatment of
CNS toxoplasmosis
Sulfadiazine
Pyrimethamine
Folinic acid
Most common predisposing condition of subdural empyema
Sinusitis
Transverse sinus thrombosis presenting with otitis media
Sixth nerve palsy
Retro orbital or facial pain
Gradinego syndrome
Chronic demyelinating disease of the CND associated with no permission infection of brain tissue with measles virus
SSPE
Rx SSPE
Is inspire
Rx syphilitic meningitis
Aqueous penicillin G
Rx meningitis C neoformans
AMPHOTERICIN B + flucytosine
Consolidation with fluconazole
Test for gram negative meningitis
Limmulus lysate
A CSF culture is positive in __ cases of meningitis
80%
Remains the drug of choice for meningococcal meningitis
Penicillin G
7 days in uncomplicated course
Regimen of meningococcal prophylaxis in close contacts
Rifampin 600 mg BID x 2 days
Alternative:
Azithromycin 500 OD x 1 dose
Ceftriaxone 250 mg 1 IM dose
Rx pneumococcal meningitis
Cephalosporin
Vancomycin
How to treat meningitis caused by Listeria monocytogenes
Ampicillin x 3 weeks
(Add gentamicin to critically ill patients)
Alternative TMP-SMX
Dose of Pen G for pneumococcal meningitis
300,000 U/kg
Bactericidal agent with antistaphylococcal activity. Novel mechanism of action: disrupts the cytoplasmic membrane
Daptomycin
