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D&T2 Exam 1 > CNS infections > Flashcards

CNS infections Flashcards

1
Q

what is the number one route of infection for acute meningitis

A

bloodstream

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2
Q

How doe infections of acute meningitis get into the bloodstream

A 
respiratory tract 
Skin 
Intestine
direct 
local extension
axonal transport
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3
Q

who usually get bacterial meningitis

A

children under age of 5

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4
Q

what is the fatality of acute bacterial meningitis

A

rapidly fatal

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5
Q

what bacteria would cause neonatal acute bacterial meningitis

A

Group B Strep
Listeria monocytogenes
E. coli

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6
Q

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

A

neisseria meningitidis

haemophilus influenzae B

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7
Q

what bacteria would cause adolescentsacute bacterial meningitis

A

Neisseria Meningitidis

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8
Q

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

A

listeria monocytogenes

gram-negative Bacilli

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9
Q

what bacteria would cause all ages acute bacterial meningitis

A

streptococcus pneumoniae

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10
Q

what is the age range for acute viral meningitits

A

less then 30 years of age

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11
Q

Is acute viral meningitis as fatal as acute bacterial meningitis

A

viral rarely causes death

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12
Q

talk about Tuberculosis Meningitidis

A

chronic,

seen as meningoencephalitis

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13
Q

what viruses can cause acute viral meningitis

A

echovirus

coxsackievirus

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14
Q

what is the gross pathology for bacterial meningitis acute

A

meninges covered by yellow-white exudate

CSF is cloudy

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15
Q

Under a microscope what cells will be inflamed for the following

  • bacterial
  • viral
  • TB
A

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

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16
Q

how will a patient present with acute meningitis

A

headache, neck pain, vomiting

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17
Q

what is the Physical exam for acute meningitis

A

NECK STIFFNESS, Kernig Sign

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18
Q

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

A

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

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19
Q

What is Waterhouse-Friderichsen syndrome

A

meningitis-associated speticemia

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20
Q

how does Waterhouse-Friderichsen syndrome impact other organs

A

hemorrhagic infarction of adrenal glands

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21
Q

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

A

meningococcal

pneumococcal meningitis

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22
Q

How does one main diagnose technique for acute meningitis

A

lumbar puncture to obtain CSF

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23
Q

what is the protein and glucose level in acute bacterial meningitis

A

increase protein

decrease glucose

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24
Q

what is the protein and glucose level in acute viral meningitis

A

protein: little elevated
glucose: normal

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25
Q

what is the protein and glucose level in acute TB meningitis

A

protein: increased more than bacterial
glucose: decreased

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26
Q

how is bacterial acute meningitis treated

A

antibiotics as soon as possible

-lumbar puncture within 30 min

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27
Q

how is viral acute meningitis treated

A

supportive

28
Q

what do infections of brain parenchyma look like

A

pus: liquefied brain and PMN’s

mass lesion

29
Q

what can cause brain parenchyma

A

bacteria (strep, staph, anaerobes)

30
Q

what happens to the adjacent brain in brain parenchyma

A

vasogenic edema

31
Q

what are the most common lobes for parenchyma

A

frontal and parietal

cerebellum

32
Q

what can brain parenchyma cause

A

increased ICP

33
Q

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

A

location determines focal neurologic signs

34
Q

what happens when Brain parenchyma goes untreated

A

death by increased ICP or rupture into ventricles

35
Q

how does a doctor confirm brain parenchyma in the office

A

CT scan or MRI

36
Q

what is the CSF like in brain parenchyma

A

normal or increased WBC and protein

glucose normal

37
Q

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

A

lumbar puncture- risk of herniation

38
Q

how does the doctor treat brain parenchyma

A
  • surgical evacuation

- antibiotics

39
Q

what is subdural empyema

A

collection of pus in subdural space

40
Q

what causes subdural empyema

A

bacterial or fungal infection of skull bones or air sinuses

41
Q

what does subdural empyema cause in the brain

A

thrombophlebitis of bridging veins, occlusions, infarction

42
Q

what are symptoms of someone who has subdural empyema

A

early fever, HA, neck stiffness

Late: focal neurologic signs

43
Q

treatment for subdural empyema

A

surgery

antibiotics

44
Q

on a macroscopic level what happens in chronic bacterial meningoencephalitis

A

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

45
Q

what are symptoms for chronic meningoencephalitis

A

headache, malaise, confusion, vomiting, low grade fever

46
Q

how does the doctor diagnose chronic meningeoncephalitis

A

lumbar puncture

-acid-fast, mycobacterial culture

47
Q

how does the doctor treat chronic meningeoncephalitis

A

antibiotics

48
Q

what are complications that arise from chronic meningoencephalitis

A

arachnoid fibrosis

- obliterative endarteritis –> arterial occlusion –> infarction

49
Q

what are symptoms for chronic meningoecephalitis (lyme disease)

A

variable: facial nerve palsies, encephalopathy

50
Q

what would chronic meningoencephalitis look like under a microscope

A

microglial nodules

scattered borrelia burgdoferi

51
Q

what does viral meningoencephalitis is what

A

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

52
Q

tropism

A

certain viruses infect certain cells or certain areas of brain

53
Q

how does one usually get viral meningoencephalitis

A

blood-borne

54
Q

how does viral meningoencephalitis effect the brain

A

perivascular lymphocytic cuffing, infiltration by other monocytes

55
Q

what are clinical symptoms for viral meningoecephalitis

A

fever, HA, brain dysfunction: acute onset

56
Q

how can a doctor diagnose viral meningoencephalitis

A

clinical picture

57
Q

what is the treatment for viral mineingoencephalitis

A

supportive

- high dose steroids for cerebral edema

58
Q

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

A

arboviruses causes epidemic cases

59
Q

what is the CSF for viral meningoencephalitis

A

pmns then lymphocytes

  • elevated proteins
  • normal glucose
60
Q

what is the histology for viral meningoencephalitis

A

perivascular lymphocytic cuffing,
necrosis with neuronophagia
- microglial nodules

61
Q

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

A
  • children and young adults (HSV-1)

- neonatal (HSV-2)

62
Q

where on the brain does viral meningoencephalitis occur HSV

A

temporal and inferior frontal lobe

orbital gyri

63
Q

what does viral meningoencephalitis do to the brain HSV

A

necrotizing, hemorrhagic encephalitis

64
Q

what is seen microscopally for viral meningoencephalitis HSV

A

intranuclear cowdry A inclusions

65
Q

HOw does one diagnose viral meningoencephalitis HSV

A

PCR to identify virus

brain biopsy

66
Q

how does one treat viral meningoencephalitis HSV

A

if early give anti-viral agents

D&T2 Exam 1 (22 decks)

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