CNS infections Flashcards
Airway
Breathing
Look: respiratory distress, increased WOB
Listen: lung sounds
Feel: trachea, percuss, expansion
RR, O2
?CXR
?ABG (lactate)
Circulation
Look: peripheral shutdown, mottled
Listen: S1+S2+0
Feel: apex beat, reduced CRT, pulse
HR (fast), BP
Investigations:
1. Temperature: high
2. ECG: normal
3. Access: IV cannulae in 2 antecubital fossae
4. FBC (WCC), UEs, LFTs, CRP
5. Blood culture
5. CT head prior to LP if focal neurology or immunocompromised to rule out high ICP
6. Fundoscopy
5.** Lumbar puncture ** within the hour
Management:
1. Isolate the patient
2. Start empirically: ceftriaxone IV 2g/ 12 hours or cefotaxime 2g IV 6 hourly + amoxicillin 2g 4 hourly in >60
3. For pneumococcal add dexamethason 10mg IV 6 hourly for 4 days
4. If > 60 add amoxicillin for listeria cover
6. IV acyclovir if encephalitis or viral
Escalate:
1. Alert senior input
2. Neuro SpR
3. ID SpR
Disability
GCS: reduced in encephalitis
PEARL
Drug chart: allergies
BM
Neuro exam: focal signs, and Kernig’s and Brudinski
Exposure
expose
rashes (non blanching)
calves
temperature
urine dip
Give prophylaxis to contacts (ciproploxacin 500mg PO)
Encephalitis
If:
- altered mental state, odd behaviour, confusion
- low GCS
- fever, headache, focal neurology
Think Encephalitis!
Viral: HSV 1+2, arboviruses, CMV, EBV, VZV, HIV
Investigations:
1. Blood cultures, serum for viral PCR, throat swab and MSU
2. Contrast enhanced CT: focal bilateral temporal lobe involement is suggestive of HSV encephalitis
3. LP: moderately increased CSF protein and lymphocytes and low glucose. Send CSF for viral PCR including HSV
4. EEG: urgent EEG showing diffuse abnormalities may help confirm a diagnosis of encephalitis
Management
1. IV acyclovir stat
2. HDU or ICU
3. Symptomatic treatment i.e. phenytoin for seizures
Contraindications for LP
- Raised ICP
- Infection at the LP site
- Coagulopathy
