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Block 5 Week 6 Dani > CNS Infection Falkenberg > Flashcards

CNS Infection Falkenberg Flashcards

1
Q

What are some ways you can get CNS infections?

A 
bacteria
viruses
fungus
parasites
others, lyme disease, syphilis
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2
Q

What is a common route of CNS infection?

A

hematogenous/venous spread

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3
Q

What kind of route of infection is this; abcess, respiratory, GI/GU, pericranial sites-sinuses, middle ear?

A

heamtogenous/venous spread

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4
Q

What are 2 less common routes of CNS infection?

A

penetrating trauma and entry through congenital defects

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5
Q

What are the three types of CNS infection?

A

meningitis
encephalitis
myelitis

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6
Q

What is meningitis?

A

infection of meninges ESPECIALLY arachnoid

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7
Q

What is encephalitis?

A

infection of the brain

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8
Q

What is myelitis?

A

infection of spinal cord

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9
Q

T/F

THe brain and spinal cord repair well

A

F, they do not repair well

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10
Q

Brain is (enclosed/closed)

A

enclosed

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11
Q

Since the brain is enclosed what does this mean for clinical purposes?

A

it means that increased cranial pressure can lead to brain herniation and necrosis!!! OH NO!

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12
Q

What can CNS infections ultimately lead to?

A

sepsis! :(

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13
Q

What are the signs and symptoms of acute bacterial meningitis?

A

Similar to migraines

i.e. headache, nausea, vomiting, fever, meningismus, altered consciousness

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14
Q

In children you dont want to miss acute bacterial meningitis, what should clue you in to check to see if the child has it?

A

If child is less than 28 days old and has a fever greater than 100.6 then you should give full septic work-up and lumbar puncture

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15
Q

What are causes of acute bacterial meningitis?

A 
S. pneumonia
H. Influenze
L. monocytogenes
Group B steptococcus
N. meningitidis
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16
Q

How do you rule out a space occupying lesion?

A

CT of head

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17
Q

What are some tools to diagnose bacterial meningitis?

A

lumbar punctures
CT
blood cultures

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18
Q

What will a gram stain tell you?

A

will tell you if you have bacteria :)

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19
Q

What are normal values of CSF?

A 
5-20 pressure
.18-.45 protein
2.5-3.5 glucose
normal gram stain
.6 glucose to CSF ratio
less than three WCC
20
Q

What is the treatment for acute meningitis?

A

antibiotics
hospitalization
steroids
supportive care

21
Q

What are the symptoms of viral meningitis?

A

headache
fever
viral syndrome
meningismus (sore and stuff without actual inflammation and infection)

22
Q

What are causes of viral meningitis?

A

enteroviruses

echovirus, coxsackie A and B

23
Q

If you have monocytes in your CSF and normal gram stain and glucose what do you have?

A

viral meningitis

24
Q

If you have monocytes and a fibrin web in your CSF what do you have?

A

fungal menigitis/TB

25
Q

What is the treatment for viral menigitis?

A

supportive care

antivirals

26
Q

T/F most cases of viral meningitis resolve after 7-10 days

A

T

27
Q

What are the signs and symptoms of encephalitis?

A 
confusion
PERSONALITY CHANGE
altered mental status
fever
seizures
28
Q

What are causes for encephalitis?

A

herpes simplex virus
varicella zoster virus
HIV
rabies virus

29
Q

How do diagnose encephalitis?

A 
H and P
CT
lumbar puncture
CSF
antibody titers
PCR of CSF for herpes encephalitis
brain biopsy (in exceptional cases)
30
Q

What are the signs and symptms of brain abscesses?

A 
headache
focal neurologic deficits
fever, chills
papilledema (w. increased ICP)
nausea, vomiting (w. increased ICP)
31
Q

T/F

you will see other signs of infection besides fever and chills in brain abscesses

A

F you will not, you will only see fever and chills and that is even rare
(this makes it difficult to diagnose)

32
Q

What is the treatment for brain abscesses?

A

antibiotics

surgical drainage

33
Q

What are common causes of brain abscesses?

A

streptococcus viridans

staphylococcus aureus

34
Q

When should you get a lumbar puncture?

A

suspected cases of meningitis and encephalitis

35
Q

What can you use if you are suspicious someone has severe headaches, MS, or subarachnoid hemorrhage?

A

lumbar puncture

36
Q

T/F

lumbar puncture can be used as a treatment

A

T for pseudotumor cerebri and increased ICP

37
Q

Why dont you want to use a quinke for a spinal tap?

A

because they give people headaches :(

cuts the dura which makes CSF leak out

38
Q

How do you give a spinal tap?

A 
tell patient
mark site
sterilize
betadine
drape
local anesthetic (lidocaine)
(use a good needle, like the gertie, sprotte, whitacre)
introducer needle
spinal needle
feel "pop" of dura
measure pressure (fill tubes)
39
Q

Where do you give lumbar puncture?

A

L2/L3

40
Q

If you cant find the correct spot with a needle what do you do?

A

pull all the way out and try again, put it in straight DO NOT BEND NEEDLES THEY CAN SNAP IN PEOPLE

41
Q

What are some complications of a lumbar puncture?

A 
spinal headache (PDPH)
nerve damage- rare
back pain
infection - rare
bleeding -rare
42
Q

How much CSF should you take out?

A

minimal possible (usually around like 1-2 CC) 10 at MAX!

43
Q

What are contraindications for spinal tap?

A

patient refusal
skin infections or abscess (dont want to spread infection into the CSF)
bleeding disorder
space occupying/ mass lesion

44
Q

Why dont you want to do a lumbar puncture with a space occupying or mass lesion?

A

You mess up fluid equilization and increase pressure cranially while decreasing pressure caudally.

45
Q

How do you fix a Dura leak that was caused by a messed up spinal tap?

A

blood patch (take epidural of blood and put the blood over the dural opening to make a patch)

Block 5 Week 6 Dani (9 decks)

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