CNS infections Flashcards by Bina Malapur

what is the number one route of infection for acute meningitis

bloodstream

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How doe infections of acute meningitis get into the bloodstream

respiratory tract 
Skin 
Intestine
direct 
local extension
axonal transport

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who usually get bacterial meningitis

children under age of 5

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what is the fatality of acute bacterial meningitis

rapidly fatal

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what bacteria would cause neonatal acute bacterial meningitis

Group B Strep
Listeria monocytogenes
E. coli

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what bacteria would cause children up to 5 years of age acute bacterial meningitis

neisseria meningitidis

haemophilus influenzae B

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what bacteria would cause adolescentsacute bacterial meningitis

Neisseria Meningitidis

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what bacteria would cause older, debilitaed, immunosuppressed acute bacterial meningitis

listeria monocytogenes

gram-negative Bacilli

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what bacteria would cause all ages acute bacterial meningitis

streptococcus pneumoniae

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what is the age range for acute viral meningitits

less then 30 years of age

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Is acute viral meningitis as fatal as acute bacterial meningitis

viral rarely causes death

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talk about Tuberculosis Meningitidis

chronic,

seen as meningoencephalitis

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what viruses can cause acute viral meningitis

echovirus

coxsackievirus

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what is the gross pathology for bacterial meningitis acute

meninges covered by yellow-white exudate

CSF is cloudy

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Under a microscope what cells will be inflamed for the following

bacterial
viral
TB

bacterial: neutrophils
Viral: lymphocytes
TB : neutrophils and Lymphocytes
All: hyperemia; fibrin

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how will a patient present with acute meningitis

headache, neck pain, vomiting

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what is the Physical exam for acute meningitis

NECK STIFFNESS, Kernig Sign

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what is the prognosis for acute bacterial, viral, TB meningitis

Bacterial: risk of death
Viral: self-limited
TB: slow progression; SEVERE: fatal outcome if not treated

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What is Waterhouse-Friderichsen syndrome

meningitis-associated speticemia

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how does Waterhouse-Friderichsen syndrome impact other organs

hemorrhagic infarction of adrenal glands

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Waterhouse-Friderichsen syndrome is most common with what type of acute meningitis

meningococcal

pneumococcal meningitis

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How does one main diagnose technique for acute meningitis

lumbar puncture to obtain CSF

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what is the protein and glucose level in acute bacterial meningitis

increase protein

decrease glucose

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what is the protein and glucose level in acute viral meningitis

protein: little elevated
glucose: normal

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what is the protein and glucose level in acute TB meningitis

protein: increased more than bacterial glucose: decreased

how is bacterial acute meningitis treated

antibiotics as soon as possible | -lumbar puncture within 30 min

how is viral acute meningitis treated

supportive

what do infections of brain parenchyma look like

pus: liquefied brain and PMN's | mass lesion

what can cause brain parenchyma

bacteria (strep, staph, anaerobes)

what happens to the adjacent brain in brain parenchyma

vasogenic edema

what are the most common lobes for parenchyma

frontal and parietal | cerebellum

what can brain parenchyma cause

increased ICP

how can a neurologist figure out where the brain parenchyma is located

location determines focal neurologic signs

what happens when Brain parenchyma goes untreated

death by increased ICP or rupture into ventricles

how does a doctor confirm brain parenchyma in the office

CT scan or MRI

what is the CSF like in brain parenchyma

normal or increased WBC and protein | glucose normal

what should you not do in the office in order to diagnose a brain parenchyma and why?

lumbar puncture- risk of herniation

how does the doctor treat brain parenchyma

- surgical evacuation | - antibiotics

what is subdural empyema

collection of pus in subdural space

what causes subdural empyema

bacterial or fungal infection of skull bones or air sinuses

what does subdural empyema cause in the brain

thrombophlebitis of bridging veins, occlusions, infarction

what are symptoms of someone who has subdural empyema

early fever, HA, neck stiffness | Late: focal neurologic signs

treatment for subdural empyema

surgery | antibiotics

on a macroscopic level what happens in chronic bacterial meningoencephalitis

fibrinous exudate in subarachnoid space at base of brain, entrap cranial nerves - hydrocephalus by blocking outlet of 4th ventricle

what are symptoms for chronic meningoencephalitis

headache, malaise, confusion, vomiting, low grade fever

how does the doctor diagnose chronic meningeoncephalitis

lumbar puncture | -acid-fast, mycobacterial culture

how does the doctor treat chronic meningeoncephalitis

antibiotics

what are complications that arise from chronic meningoencephalitis

arachnoid fibrosis | - obliterative endarteritis --> arterial occlusion --> infarction

what are symptoms for chronic meningoecephalitis (lyme disease)

variable: facial nerve palsies, encephalopathy

what would chronic meningoencephalitis look like under a microscope

microglial nodules | scattered borrelia burgdoferi

what does viral meningoencephalitis is what

infection of brain parenchyma with associated meningeal inflammation with or without spinal cord involvement

tropism

certain viruses infect certain cells or certain areas of brain

how does one usually get viral meningoencephalitis

blood-borne

how does viral meningoencephalitis effect the brain

perivascular lymphocytic cuffing, infiltration by other monocytes

what are clinical symptoms for viral meningoecephalitis

fever, HA, brain dysfunction: acute onset

how can a doctor diagnose viral meningoencephalitis

clinical picture

what is the treatment for viral mineingoencephalitis

supportive | - high dose steroids for cerebral edema

what type of viruses cause what type of cases for viral meningoencephalitis

arboviruses causes epidemic cases

what is the CSF for viral meningoencephalitis

pmns then lymphocytes - elevated proteins - normal glucose

what is the histology for viral meningoencephalitis

perivascular lymphocytic cuffing, necrosis with neuronophagia - microglial nodules

what are the 2 groups involved in viral meningoencephalitis and what virus causes them

- children and young adults (HSV-1) | - neonatal (HSV-2)

where on the brain does viral meningoencephalitis occur HSV

temporal and inferior frontal lobe | orbital gyri

what does viral meningoencephalitis do to the brain HSV

necrotizing, hemorrhagic encephalitis

what is seen microscopally for viral meningoencephalitis HSV

intranuclear cowdry A inclusions

HOw does one diagnose viral meningoencephalitis HSV

PCR to identify virus | brain biopsy

how does one treat viral meningoencephalitis HSV

if early give anti-viral agents