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Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Define Meningitis

A

Swelling and inflammation of the membranes covering the brain and spinal cord

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2
Q

Define Encephalitis

A

Inflammation of the brain

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3
Q

Define Nosocomial Infections

A

Hospital acquired

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4
Q

Define Abscess

A

Confined pocket of pus that collects in tissues, organs, or spaces inside the body

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5
Q

Community Bacterial Meningitis Bugs (Newborn-1 month)

A

Group B Strep- 70%

H. influenzae, Listeria, S. pneumoniae- 30%

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6
Q

Community Bacterial Meningitis Bugs (1-23 months)

A

S. pneumoniae- 50%
N. meningitidis- 30%
Group B. Strep- 15%

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7
Q

Community Bacterial Meningitis Bugs (2-18 years)

A

N. meningitidis- 60%
S. pneumoniae- 25%
H. influenzae- 8%

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8
Q

Community Bacterial Meningitis Bugs (19-50 years)

A

S. pneumoniae- 60%
N. meningitidis- 20%
H. influenzae- 10%
Listeria- 6%

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9
Q

Community Bacterial Meningitis Bugs (50+)

A

S. pneumoniae- 70%
Listeria- 20%
N. meningitidis, group B strep, H. influenza- 10%

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10
Q

Nosocomial Bacterial Meningitis Epidemiology

A

Disease of neurosurgical patients, trauma, etc

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11
Q

Nosocomial Bacterial Meningitis Bugs

A 
E. coli, K. pneumoniae, P. auruginosa- 33%
Strep-9%
S. aureus- 9%
Coagulase negative staph- 9%
Listeria- 8%
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12
Q

Changes in Epidemiology for Bacterial Meningitis

A

Decline in H. influenza
Increased incidence of S. pneumo
Shift from pediatrics to adults
Increase incidence of antibiotic-resistant organisms (PCN & Cephalosporin)

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13
Q

Predisposing Factors of Bacterial Meningitis

A

Colonization of the nasopharynx (N. meningitides, S pneumonia, H. influenza)
Direct entry of organisms into the CNS from contiguous infection, trauma, neurosurgery, a CSF leak, or medical device

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14
Q

Host Risk Factors for Bacterial Meningitis

A

Asplenia
Corticosteroid use
immune-compromised/HIV infection
Exposure to someone with menigitis

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15
Q

Pathogenesis of Bacterial Meningitis

A

Virulence factors of pathogen
CSF has inadequate humoral immunity
Bacteria produce inflammatory response
Leads to vasogenic brain edema, increase ICP, brain ischemia, cytotoxic injury & neuronal apoptosis

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16
Q

Presentation of Bacterial Meningitis

A

Symptoms of 2-3 days
FEVER >38 C
NUCHAL RIGIDITY
CHANGE IN MENTAL STATUS

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17
Q

Other Symptoms of Bacterial Meningitis

A 
Headache
Photophobia
Characteristic rash
N/V
Seizures
Focal neurological deficits
Papilledema
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18
Q

Exanthem

A

Small hemorrhages under the skin

Rash doesn’t fade under pressure

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19
Q

Exanthem Pathogenesis

A 
Septicemia
Wide spread endothelial damage
Activation of coagulation
Thrombosis
Platelet aggregation
Reduction of platelets
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20
Q

Physical Exam Tests

A

Kerning Sign

Brudzinski Sign

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21
Q

Kerning Sign

A

Supine position, flex hip 90 degressm inability or reluctance to allow full extension of the knee when the hip is flexed

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22
Q

Brudzinski sign

A

Spontaneous flexion of hips during attempted passive flexion of the neck

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23
Q

Meningitis Workup

A 
CBC with differential
CMP
UA
Blood cultures
Lumbar Puncture
Possible CT
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24
Q

Head CT prior to LP for Meningitis

A

Immunocompromised

Hx of seizure

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25
Q

Reasons for CT in Bacterial Meningitis

A

Identify contraindications to LP
Evidence of head trauma, sinus/mastoid infection, skull fracture, & congenital anomalies
May identify cerebral edema, effusion, hydrocephalus, abscess
Reveal cause of infection

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26
Q

Normal LP values

A 
Pressure: 70-180
Appearance: clear, colorless
CSF protein: 15-45 mg/dL
Gamma globulin: 3-12% of protein
CSF glucose 45-85 mg/100mL (OR >2/3 serum)
CSF WBC:
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27
Q

Bacterial Meningitis LP

A 
Elevated opening pressure
Cloudy, purulent
Leukocytosis (1000 to 5000)
Protein 100-500 mg/dL
Glucose
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28
Q

Gram Positive Diplococci in Bacterial Meningitis

A

S. pneumoniae

29
Q

Gram Negative Diplococci in Bacterial Meningitis

A

N. meningitidis

30
Q

Small Pleomorphic Gram Negative Coccobacilli in Bacterial Meningitis

A

H. influenzae

31
Q

Gram Positive rods and coccobaccila

A

Listeria

32
Q

Empiric Treatment of S. pneumonia and Meningococcal Bacterial Meningitis

A

Cefotaxime (Claforan)
Ceftriaxone (Rochephin)
Either of above + Vancomycin

33
Q

Empiric Treatment of L. monocytogenes Bacterial Meningitis

A

Ampicilling + gentamycin

PCN allergy: TMP-SMX or meropenem

34
Q

Nosocomial Bacterial Meningitis

A

Ceftazidime + Vacomycin

35
Q

Risk Factors for Drug-Resistant S. pneumoniae

A 
Extremes of age
Recent antibiotic treatment
Significant comorbid disease
HIV infection
Immunodeficiency
Day care parent/sib
Recent hospitalization
Congregate settings
36
Q

Neurologic Complications

A 
Increased ICP
Cerebral edema
Seizures
Cranial nerve palsies
Hemiparesis
37
Q

Cerebrovascular Complications

A 
Vessel wall irregularities
Focal dilatations
Arterial occlusions
Focal arterial bleeding
Venous thrombosis
38
Q

Sensorineural Hearing Loss

A

Greater with S. pneumoniae

39
Q

Role of Steroids

A

Attempt to diminish the rate of hearing loss, cerebral edema, other neurologic complications
Reduces mortality and neurologic disability in patients with GCS scores of 8-11
Continue if S. pneumoniae

40
Q

Prevention of Bacterial Meningitis

A

Avoid sharing saliva, cups, utensils
Good hand washing
Vaccines: H. flu, pneumococcal conjugate, pneumococcal polysaccharide, meningococcal conjugate, Serogroup B meningococcal

41
Q

Adults Should Get Quadrivalent Meningococcal Conjugate Vaccine if:

A

Complement deficiency
Asplenia
Microbiologist frequently exposed to N. meningitidis
Traveling to countries where disease common
Population at risk due to outbreak
College students
Military recruits

42
Q

Aseptic Meningitis

A

Clinical and lab evidence for meningeal inflammation with negative bacterial cultures

43
Q

Cause of Aseptic Meningitis

A 
Enterovirus
Mycobacteria
Fungi
Spirochetes
Parameningeal infections
Medications
Malignancy
44
Q

Aseptic Meningitis Presentation

A

Fever
HA
Stiff neck
Photophobia

45
Q

Aseptic Meningitis Approach

A

Comprehensive hx
CSF clear- observe
Treatment supportive

46
Q

Define Encephalitis

A

Inflammation of the brain parenchyma, manifested by neurologic dysfunction

47
Q

Causes of Encephalitis

A 
Viral
Postinfectious
Autoimmune
Paraneoplastic
Medication induced
48
Q

Clinical Presentation of Encephalitis

A 
Altered mental status
Seizures common
Focal neurologic abnormalities
Exaggerated DTRs
Pathologic reflexes
Motor/senosry deficits
Altered behavior
Personality changes
Speech or movement disorders
Hemiparesis
49
Q

Imaging fo Encephalitis

A

CT- lesion, abscess
MRI- demyelination
EEG-abnormal

50
Q

Complications of Encephalitis

A 
Status epilepticus
Cerebral edema
SIADH
Cardiorespiratory failure
DIC
Death
51
Q

Difference between Meningitis and Encephalitis

A

Meningitis- cerebral function remains intact
Encephalitis- abnormalities in brain function; meningeal irritation absent
Meningoencephalitis is used to describe both

52
Q

Viral Etiologies of Encephalitis

A

HSV1
3 alpha- western, easter, and venezualan equine encephalitis
5 flaviviruses- west nile, yellow fever
Bunyviruses- Cali

53
Q

Non-viral/Post-infectious Etiologies of Encephalitis

A 
Lyme disease
Rocky Mountain spotted fever
Rabies encephalitis
Syphilis
Tuberculosis
54
Q

Viral Encephalitis Findings

A

Elevated CSF WBCs

Elevated protein but

55
Q

West Nile Virus Signs and Symptoms

A 
Fever
Malaise
Stiff Neck
Sore Throat
N/V
Stupor-Convulsions-Coma
56
Q

Signs of Upper Motor Neuron Lesion in West Nile Virus

A

Exaggerated DTRs
Absent superficial reflexes
pathologic reflexes
Spastic paralysis

57
Q

West Nile Virus CSF

A

Increase protein
Increased opening pressure
Lymphocytic leukocytosis

58
Q

Rocky Mountain Spotted Fever Signs & Symptoms

A 
Fever
Headache
Nausea
Rash
Hyponatremia
Thrombocytopenia
Mild increase in LFTs
59
Q

Rocky Mountain Spotted Fever CSF

A

Increased Lymphocytes/PMNs
Increased Protein
Negative gram stain

60
Q

Rocky Mountain Spotted Fever Diagnosis

A

Clinical Suspicion

61
Q

Treatment for Rocky Mountain Spotted Fever

A

Doxycycline

62
Q

Rocky Mountain Spotted Fever Big Points

A 
Empiric treatment
Hyponatremia
Low platelets
Elevated LFTs
DON'T WAIT FOR RASH
63
Q

Lyme Disease Stages

A

Erythema migrans rash
Multiple EM lesions
Late/chronic: persistent arthritis, subtle encephalopathy/polyneuropathy

64
Q

Treatment of Early Lyme Disease

A

Doxycycline
Amoxicillin
Cefuroxime

65
Q

Treatment of Late Lyme Disease

A

Cefotaxime

Penicillin G

66
Q

Define Brain Abscess

A

Pus filled cavity ringed by granulation tissue and outer fibrous capsule surrounded by edematous brain tissue

67
Q

Pathophysiology of Brain Abscess

A 
Chronic pulmonary infections
Skin infections
Pelvic infections
Intra-abdominal infections
Esophageal dilation
Bacterial endocarditis
Cyanotic congenital heart disease
68
Q

Clinical Features of Brain Abscess

A

Triad- HA, FEVER, FOCAL DEFICIT
Toxic appearance
Seizure, vomiting, confusion, obtundation
Frontal lobe- hemiparesis
Temporal lobe- hemonymous superior quadrant visual field defect or aphasia
Cerebellum- limb incoordination or nystagmus

69
Q

Diagnostics of Brain Abscess

A

CT with Contrast
MRI
Needle guided biopsy

Neurology (10 decks)

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