CNS Infections Flashcards

1
Q

Encephalitis Causes

A

Herpesviruses (mot common)
arbovirus
enteroviruses
EBV

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2
Q

Meningitis Causes

A

Aseptic - viral cause
Septic - from another source (usually resp. source)
–Group A Strep and E. Coli in infants
–Listeria is very young and old
–Strep. pneumoniae and N. mennigitis in young adults

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3
Q

Meningitis Presentation

A

Classic is fever, stiff neck, headache - but only in 44% of meningitis cases

N/V, headache, photophobia can occur but not specific

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4
Q

Encephalitis Presentation

A

Similar to meningitis but more likely to have altered LOC, focal neuro signs, seizures

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5
Q

Kernig Sign

A

patient in the supine position resists passive knee extension when the hip is fully flexed on the abdomen

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6
Q

Brudzinski signs

A

patient in the supine position actively flexes the hips when the neck is passively flexed

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7
Q

Poor Prognosis Signs of CNS Infection

A

Purpura and petechiae are often associated with rapidly progressing meningococcemia - may indicate DIC

Lethargy, hypotension, neuro compromise signs are also poor prognosis signs

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8
Q

CNS Diagnostics

A
Blood cultures (2 sets)
CBC, Coags, ESR, CRP
Lumbar Puncture (but not if ICP is increased)
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9
Q

LP Findings

A

Bacterial Meningitis - Opening pressure increased, High WBC is CSF with 80% neutrophils, high protein, low glucose

Viral Meningitis - Opening pressure normal / slightly high, elevated WBC mostly lymphocytes, slight protein increase, glucose normal

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10
Q

Meningitis Management

A

ED Refer!
IV Dexamethasone to minimize inflammation
IV antibiotics after blood cultures but can be done before CT / LP

If viral, supportive care, careful fluid use to prevent increasing ICP
Consider antivirals if HSV or VZV suspected

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11
Q

A patient is brought to the emergency department with fever, lethargy, and headache without meningeal signs. The examination reveals hypotension and lethargy and the examiner notes petechiae on the patient’s trunk.

What do these findings indicate?

A

Petechiae are an ominous sign, indicating a rapidly progressing meningococcemia.

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