CNS infections

Question 1

Normal pathogenesis of meningitis

Answer 1

bacteria in blood cross choroid plexus into subarachnoid space (hematogenous). Inflammation leads to vasogenic edema and increase ICP

Question 2

triad of bact meningitis presentation

Answer 2

fever, stiff neck, HA (with later mental status change)

Question 3

normal protein, glucose, wbc (and type) in CSF

Answer 3

15-50, 40-80, 0-10 (lymphs)

Question 4

Changes to CSF comp in bacterial meningitis, TB/fungal, viral

Answer 4

^protein, decreased glucose, ^WBC (>50%PMNs); same except lymphs are predom WBC; mostly normal

Question 5

most common causes of bacterial meningitis in adults? in neonates? Children and teens?

Answer 5

Strep pneumoniae; GBS, E coli, L monocytogenes (and flu in nonvaccinated infant); N meningitidis (from URI)

Question 6

define aseptic meningitis, most common cause

Answer 6

cause not apparent after stains and cultures of CSF. viral, ibuprofen

Question 7

Normal bact meningitis treatment

Answer 7

ceftriazone, vancomycin, ampicillin

Question 8

HSV encephalitis: what kind of encephalopathy, route of transmission, what virus, what tx

Answer 8

focal, esp frontotemporal region. retrograde transneuronal spread. HSV1 (hsv2 causes meningitis). Acyclovir

Question 9

Most common route of spread for encephalitis. What organisms?

Answer 9

hematogenous. HSV1, WNV, Rabies, HIV, borrelia burgdorferi, trep pallidum (syphilis)

Question 10

triad of brain abcess presentation.

Answer 10

fever, HA, focal neurologic deficit. (earlier than meningitis)

Question 11

what causes most symptoms in brian abcess

Answer 11

space occupying lesion (not infection)

Question 12

spinal epidural acess: presentation

Answer 12

fever and back pain, staph aureus

Question 13

tx of bact meningitis

Answer 13

start on ab’s immediately, lumbar puncture b/w L4-L5 (SC ends at L2, subarachnoid ends at S2)