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Neurology_Clinical Medicine > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What does the Pia and the Arachnoid make up?

A

Leptomeninges

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2
Q

What is infected with meningitis?

A

Leptomeninges

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3
Q

What does the Pia matter create?

A

Is the inner layer that is tightly adhered to the brain parenchyma which forms the Choroid Plexus, which makes CSF

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4
Q

What is important to do immediately after giving an epidural?

A

Optimize patient positioning to appropriately numb targeted area

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5
Q

Why is bacterial meningitis a can not miss diagnosis?

A

Without treatment within 24 hours can be fatal 70-100% of the time

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6
Q

Who is more likely to get bacterial meningitis?

A

Children < 2 months (but median age is 42- so really anyone)

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7
Q

What are some predisposing factors for bacterial meningitis?

A

Prior viral infection
Household crowding (college kids or military)
Active and passive smoking
Occupation risks (us and microbiologists)

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8
Q

What are the top three bacteria to cause bacterial meningitis?

A

S. pneumonia, N. meningitis, L. monocytogenes

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9
Q

What is the most common bacterial cause of meningitis in newborns?

A

Group B Strep

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10
Q

What is the most common bacterial cause of meningitis in teenagers?

A

N. meningitis

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11
Q

What is a common place of entry for bacterial organisms that go on to cause bacterial meningitis?

A

Nasopharynx up to optic chiasm

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12
Q

What are the the top three infections that lead to meningitis?

A

Otitis media, sinusitis, or dental infections

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13
Q

What is the most common place of BBB cross over in bacterial meningitis?

A

Choroid plexus and postcapillary veins

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14
Q

What is the inflammatory response for bacterial meningitis?

A

Further breakdown of the BBB, cerebral edema and increased ICP which can lead to herniation

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15
Q

What are the two N. meningitidis vaccines?

A

Meningococcal conjugate vaccine and MenB

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16
Q

What is the antibiotic of choice to treat bacterial meningitis caused by N. meningitidis?

A

Ceftriaxone

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17
Q

What is the antibiotic of choice to treat bacterial meningitis caused by S. pneumoniae?

A

Vancomycin plus ceftriaxone

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18
Q

What type of bacterial meningitis is most likely to have seizures?

A

Meningitis caused by Listeria Monocytogenes (older patients)

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19
Q

What is the antibiotic of choice to treat bacterial meningitis caused by listeria?

A

Ampicillin or Penicillin (if allergic, Bactrim)

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20
Q

What symptom (neurological deficit) seen in listeria meningitis?

A

Ataxia

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21
Q

What type of meningitis is most common in those that arn’t vaccinated?

A

Haemophilus Influenzae (most common in kids)

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22
Q

Why are neonates more susceptible to meningitis?

A

Have increased permeability of the BBB

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23
Q

What is the classic triad of presentation for bacterial meningitis?

A

Fever, stiff neck (nuchal cord rigidity), change in mental status (more lethargy)

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24
Q

How can babies present with meningitis?

A

Poor feeding, irritable, moaning cry, abnormal tone (abnormal posturing), vacant staring, lethargic, tense fontanelle, cyanosis

25
Q

What two tests can you do as part of your physical exam to diagnose meningitis?

A

Brudzinski and Kernig signs

26
Q

What is the rash that will classically present in N. meningitidis meningitis?

A

Petechiae and palpable purpura rash

27
Q

What will you see on your CBC in meningitis?

A

Leukocytosis with Left Shift
May have thrombocytopenia

28
Q

What labs are you going to order for working up bacterial meningitis?

A

CBC
Coagulation studies
CMP (elevated anion gap)
2 sets of blood cultures
Head CT
LP
?MRI (may show enhancements of the leptomeninges)

29
Q

In real life (not textbook) are you ordering a CT when diagnosing meningitis?

A

YES! You need to rule out the other stuff that is going to be bad (abscess that would be contraindicated for an LP)

30
Q

How does the patient need to be lying for a lumbar puncture?

A

Lateral decubitus

31
Q

What are the contraindications for an LP in working up meningitis?

A

Anticoagulated
Concern for herniation (elevated ICP)
If platelets < 50,000

32
Q

What is the normal glucose level of CSF?

A

45-85

33
Q

What is the glucose in bacterial meningitis?

A

< 40 (low)

34
Q

What is the color of bacterial meningitis vs. viral meningitis?

A

Turbid/cloudy in bacterial meningitis and clear with viral

35
Q

What WBC is going to be elevated in viral meningitis?

A

Lymphocytes

36
Q

What is the order of treatment for meningitis?

A

ABC’s
Start antibiotics and antivirals
Head CT
LP
Treat Shock
Start steroids (dexamethasone)
Exposure prophylaxis

37
Q

What is the classic antibiotic (broad spectrum) regimen for antibiotics?

A

Ceftriaxone, Vancomycin, Ampicillin

38
Q

Who else do you need to treat when someone is diagnosed with meningitis?

A

Anyone in close contact with patient for more than 8 hours of contact

39
Q

How long does chronic meningitis last prior to presentation?

A

> 30 days

40
Q

How does chronic meningitis present?

A

Often have cranial nerve findings and mental status change

41
Q

What is aseptic meningitis most typically associated with?

A

Enterovirus

42
Q

When is viral meningitis more common?

A

Summer and fall, enteroviruses most commonly peak in summer and fall

43
Q

What viruses cause viral meningitis?

A

Enterovirus
Herpes Virus
Acute HIV

44
Q

What two presenting symptoms are more common in bacterial meningitis than viral meningitis?

A

Photophobia and seizures are more common in bacterial

45
Q

What is the treatment for viral meningitis?

A

Depends on virus (acyclovir)
Support patient with dark and quite room
Tylenol for HA, fever, pain

46
Q

What can direct you to bacterial meningitis over aseptic meningitis or encephalitis?

A

CSF lactate >3.5mmol/L

47
Q

What is encephalitis?

A

Inflammation of the brain parenchyma

48
Q

What are the 6 V’s of encephalitis?

A

Vacation
Vaccination
Vectors
Viruses
Veterinary sources
Vital statistics (is there an outbreak)

49
Q

Beside the overlapping symptoms with meningitis, how is a patient with encephalitis going to present?

A

Altered mental status (truly confused, agitated, obtunded, personality change)
Focal neurologic abnormalities

50
Q

What is a major criteria diagnostic criteria for encephalitis?

A

AMS + 2 minor criteria (fever, seizure, neuro findings, CSF pleocytosis, parenchyma on MRI, EEG abnormality)

51
Q

What imaging are you going to order for viral meningitis?

A

MRI, CT may look normal initially

52
Q

What lobe is going to be typically involved in viral meningitis?

A

Temporal lobe

53
Q

What is the treatment for viral meningitis?

A

Acyclovir all day long!

54
Q

How is a brain abscess defined?

A

Focal collection of infection in the brain parenchyma

55
Q

What are the typical infections of spread leading to a brain abscess?

A

Otitis media
Mastoiditis
Dental infection

56
Q

What cranial nerve palsy is usually present in a brain abscess?

A

CN VI due to elevated ICP

57
Q

Do you use contrast when looking for an abscess?

A

Yes

58
Q

What broad spectrum coverage is used in treating a brain abscess?

A

IV Vancomycin
IV Metronidazole (anerobes)
IV Ceftriaxone

for 4-8 weeks

59
Q

When is surgery indicated in a brain abscess?

A

Secondary to a TBI and material in the abscess
Fungal
Loculated (walls within the abscess)
No improvement after a week
Elevated ICP
Increased size

Neurology_Clinical Medicine (13 decks)

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