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CNS Infections Flashcards

1
Q

What are the causes of CNS infections

A
  • bacteria
  • viruses/aseptic
  • aseptic/meds
  • fungi
  • parasites
  • prion
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2
Q

define meningitis

A

inflammation of membranes surrounding the brain

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3
Q

define encephalitis

A

inflammation of brain parenchyma

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4
Q

define myelitis

A

inflammation of spinal cord

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5
Q

What determines the presentation of meningitis/encephalitis

A

the location of the infection, not the organism

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6
Q

Which organisms cause acute onset meningitis

A

viruses, aerobic bacteria

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7
Q

Which organisms cause subacute or chronic meningitis

A

anaerobic bacteria, tuberculosis, fungi

T. pallidum

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8
Q

Describe the pathophys of meningitis/encephalitis

A

organism enters body via GI, resp, skin nidus. Replication begins. Travels to CNS by blood, peripheral nerves, bone and penetrates the blood/CSF barrier, infects endothelial cells of cerebral blood vessels, or through infected emboli.

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9
Q

Describe the hallmarks of bacterial meningitis

A
  • abrupt, acute inflammatory process
  • acute onset of severe headache, fever, stiff neck
  • multiple infectious causes
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10
Q

What are the 2 common organisms in bacterial meningitis

A
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11
Q

What is the most common cause of bacterial meningitis

A

staphylococcus pneumoniae among adults and newborns

neisseria meningitidis on college campuses

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12
Q

What are the goals of a work-up for bacterial meningitis

A

start IV, start abx, get lumbar puncture within 60 mins

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13
Q

Describe the big 3 symptoms for bacterial meningitis

A

- fever, stiff neck, altered mental status

  • also HA, fever, N/V, pain
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14
Q

What signs on physical exam would potentially be seen in bacterial meningitis

A
  • fever
  • nuchal rigidity to neck flexion
  • kernig sign
  • brudzinksi sigh
  • rash (n. meningitidis)
  • do lumbar puncture
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15
Q

What might be on a DDx for bacterial meningitis

A
  • non-infectious meningitis
  • stroke
  • encephalitis
  • vasculitis
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16
Q

What labs are done for bacterial meningitis

A
  • WBC & ESR high
  • BMP to assess electrolytes and kidney
  • blood cultures to ID organism
  • CSF analysis through LP (ID organism, susceptibility testing)
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17
Q

Describe LP opening pressure

A
  • rate of production and drainage of CSF
  • measured over 1 min with manometer while obtaining LP sample
    - increased indicates infection, inflammation, hemorrhage
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18
Q

How to interpret LP results

A
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19
Q

What are some AEs of a LP

A
  • headache
  • CSF leak
  • pain
  • iatrogenic menigitis
  • nerve root injury
    - uncal herniation
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20
Q

Who should get a CT prior to a LP

A
  • immunocompromised
  • hx CNS disease
  • new onset seizure
  • papilledema
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21
Q

Describe papilledema

A
  • increased pressure in or around brain causing swelling of the optic nerve inside the eye, blurring of optic disc, enlarged retinal veins
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22
Q

What are some contraindications of an LP

A
  • brain shift seen on CT
  • clinical signs of impending herniation
  • thrombocytopenia
  • spinal epidural abscess
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23
Q

What is the order of operations in bacterial meningitis management

A
  • blood cultures
  • empiric abx therapy
  • CT if needed
  • LP if not contraindicated
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24
Q

Describe the empiric antimicrobial treatment for bacterial meningitis

A
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25
Should steroids be used with treatment of bacterial meningitis
Recommended only in high income countries (dexamethasone) - consider for adults and children especially with S. pneumo
26
Describe the mortality of bacterial meningitis
10% overall but varies by organism (higher for s. pneumo)
27
What are some complications of bacterial meningitis
- CN palsy - focal deficits - sensorineural - seizures - hydrocephalus - memory/gait/etc.
28
What is the etiology of aseptic meningitis
**- viral** - TB, mycoplasma, lyme, fungal - meds - CNS lymphoma - autoimmune
29
What differentiates aseptic from bacterial meningitis
- more benign and self limited - lymphocytic cellular response - routine bacterial cultures are negative
30
Describe the presentation of viral meningitis
- fever, HA, irritation of meninges, photophobia - malaise, muscle aches, N/V, diarrhea - **mild** lethargy
31
What is the etiology of viral meningitis
**- enteroviroses (coxsackieviruses)** - varicella zoster - HSV2 - EBV - arbovirus - HIV - influenza or mumps
32
What diagnostic testing is done with viral meningitis
- LP - bacterial cultures: negative - PCR testing on CSF - can culture other sites and do serology
33
define lymphocytic pleocytosis
increase in WBCs in the CSF
34
How to treat viral meningitis
- treat symptoms - begin as if treating bacterial meningitis if severely ill (acyclovir for HSV, EBV, VZV)
35
Prognosis of viral meningitis
super great - 1-2 weeks, sometimes develop chronic headaches
36
Who gets admitted with viral meningitis
- elderly - immunocompromised - uncertain diagnosis
37
Who may be susceptible to TB/fungal meningitis
- malnourished, debilitated, immunosuppressed - chronic, weeks/months of feeling unwell
38
What might labs show for TB/fungal meningitis
elevated protein and low glucose found in CSF
39
Mortality for TB/fungal meningitis
- 20-50% - consult infectious disease
40
What can cause spirochete aseptic meningitis (chronic)
- syphilis - lyme
41
What is the etiology of encephalitis
- virus reaching brain by hematogenous route - associated with meningitis - same organisms involved as viral meningitis **- neuronal necrosis and lysis of glial cells causing cerebral edema**
42
What organisms are common in encephalitis
- epidemic west nile arbovirus - HSV1 is most common - measles virus
43
describe the presentation of encephalitis
abrupt onset of symptoms - HA - AMS (obtunded/unresponsive) - seizures - hyperreflexia - +babinski - focal neuro findings - **no nuchal rigidity, normal kernigs and brudzinski**
44
What might be on the DDx for encephalitis
- vascular disease - abscess - other infection - tumor - SLE, autoimmune
45
Describe the work up for encephalitis
- EEG: abnormal, shows diffuse bilateral slowing, seizure - CSF looks similar to viral meningitis - opening pressure: normal or elevated - WBC: lymphocyte predominance - protein: elevated - **CT/MRI normal early on but then may show edema, necrosis, hemorrhage - PCR or serologic testing
46
Management of encephalitis
Symptomatic care - ASMs - hyperventilation and mannitol for increased ICP - steroids = controversial - early acyclovir for HSV - rehab cognitive impairment
47
Prognosis for encephalitis
Depends on infectious agent - Mumps = excellent - arbovirus = reasonable (15% mortality, up to 25% dementia, seizures, focal deficits) - HSV, others = poor (20-40% mortality) - rabies = fatal
48
Describe primary amebic meningoencephalitis (PAM)
- rare, extremely fatal - Naegleria fowleri (brain eating amoeba) - presents as HA, fever, N/V, meningoencephalitis symptoms - death due to brain swelling
49
How can someone get PAM (brain amoeba)
- lives in soil, washes into pond/lakes - enters the nose - **get a good social/travel history** - swimming, diving, body of water, neti pot, religious nasal cleaning
50
How to treat PAM
- consult ID - multi drug, like bacterial meningitis until ruled out
51
Describe a the pathophys of a brain abscess
52
What causes brain abscesses
- direct extension after surgery, infections from trauma, hematogenous spread
53
What is the most common organism in brain abscess
**- bacteriodes fragilis** - staph aureus post trauma - fungi and parasites in immunocompromised
54
Describe the presentation of brain abscesses
- subacute onset of symptoms from localized brain infection - symptoms result from increased intracranial pressure - symptoms depend on location in the brain - headache, lethargy, intermittent fever, focal/generalized seizure **- classic triad of headache, fever, focal neuro deficit**
55
What is on the DDx for brain abscesses
- bacterial meningitis - brain cancer - epidural abscess - focal encephalitis
56
What is this
brain abscess
57
Work up for a brain abscess
- neurosurgical needle aspiration with gram stain and culture - EEG often abnormal, localized slowing - LP: **potentially dangerous** - blood culture + in 10%
58
Management of a brain abscess
- abx therapy, surgical drainage thru aspiration/excision - broad spectrum abx for aerobic and anaerobic coverage (4-8 weeks) - mannitol for cerebral edema - ASMs
59
What is a prion
protein normally made by neurons that is misfolded into abnormal infectious particle that is hard to kill - can be transmitted thru inoculation or hereditary
60
What are the common forms of prion disease
- CJD (creutzfeldt-Jakob) - GSS - fatal familial insomnia - Kuru - bovine spongiform (mad cow)
61
Presentation of prion disease
subacute to chronic progressive dementia, fatal of 6 mos - 2 years - memory loss, impaired judgement, intellectual decline - myoclonis
62
workup for prion disease
Prion present in CSF, brain, pituitary, peripheral nerves - hard to diagnose - labs mostly normal
63
Steps of diagnosing and treating CNS infections
64
Brain abscess prognosis
- mortality significantly better now = 15%
65
Neuro sequelae of brain abscess
in 50% - seizures - focal deficits

Neuro (22 decks)

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