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clin med III final > CNS infections > Flashcards

CNS infections Flashcards

1
Q

what organisms cause meningitis in neonates from exposure during delivery

A
  • E-coli
  • Group B strep
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2
Q

what organisms that colonize the nasopharynx (sinusitis, otitis media, mastoiditis) cause meningitis

A
  • S. pneumo
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3
Q

what organisms are prevelant in crowded conditions that cause meningitis

A
  • N. meningitidis
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4
Q

what organisms cause meningitis after head trauma

A
  • staph
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5
Q

most common pathogens causing meningitis in ages 3 months - 55 years

A
  • S. pneumonia
  • H. influenza
  • N. meningitides
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6
Q

meningitis causes which results in increased ICP and decreased cerebral perfusion

A

cerebral edema

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7
Q

classic triad of meningitis

A
  • fever
  • nuchal rigitidity
  • altered mental status
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8
Q

what tests test for nuchal rigitidy

A
  • kernigs sign
  • brudzindki’s sign
  • jolt accentuation test
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9
Q

jolt accentuation test

A
  • rotate head quickly back and forth
  • positive: headache gets worse
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10
Q

which pathogen which causes meningitis is associated with petechiae and palpable purpura

A
  • N. meningitidis
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11
Q

kernig’s sign

A
  • inability or reluctance to allow full extension of knee when hip is flexed at 90 degrees
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12
Q

Brudzinski’s sign

A
  • spontaneous flexion of hips during attempted passive flexion of neck
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13
Q

diagnostic evaluation of meningitis

A
  1. blood cultures x 2 (before abx)
  2. CT scan?
  3. LP
  4. labs
    1. CBC, cmp, ESR, CRP
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14
Q

what glucose findings in CSF is consistent with bacterial meningitis

A
  • decreased glucose in CSF (< 40)
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15
Q

when should you order a CT scan prior to a LP

A
  • immunocompromised
  • hx of CNS dz
  • new onset sz
  • papilledema
  • ALOC
  • focal neurological deficit
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16
Q

if mass lesion or evidence of increased ICP is present on CT, there is a risk of when performing LP

A

cerebral herniation

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17
Q

treatment for meningitis

A
  • do not delay tx
  • empiric IV abx immediately after LP
    • if LP delayed, begin abx after blood cultures obtained
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18
Q

tx for newborn with meningitis

A
  • ampicillin + cefotaxime
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19
Q

tx for person aged 1 month-50 yrs with meningitis

A
  • third gen cephalosporin (ceftriaxone) + vancomycin
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20
Q

tx for person aged > 50 yrs with meningitis

A
  • ceftriaxone + ampicillin + vancomycin
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21
Q

tx for immunocompromised person with meningitis

A
  • cefepime + ampicillin + vancomycin
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22
Q

why is dexamethasone used as adjuvant in tx of meningitis

A
  • decreases rate of hearing loss and decreases morbidity and mortality
    • particularly with pneumococcal meningitis
  • initiate before or at same time as abx therapy
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23
Q

when should you continue to use dexamethasone as adjuvant in tx of meningitis? what should you consider adding

A
  • only continue if gram stain or blood culture + for S. pneumoniae
    • consider adding Rifampin if steroid continued
24
Q

vaccinations are available for which pathogens that can cause meningitis

A
  • S. pneumoniae
  • N. meningitidis
  • H. influenzae
25
Q

meningitis post exposure prophylaxis

A
  • ceftriaxone
26
Q

what is aseptic meningitis

A
  • viral meningitis
    • ​clinical evidence of meningeal inflammation but bacterial cultures are negative
27
Q

most common cause of viral meningitis

A
  • enterovirus
28
Q

viral meningitis presents similarly to bacterial meningitis with added

A
  • viral type symptoms
    • diarrhea
    • URI
    • myalgias
29
Q

diagnostic evaluation of viral meningitis

A
  1. blood cultures x 2 (before abx)
  2. CT?
  3. LP
  4. CBC, CMP, ESR, CRP
30
Q

what glucose findings in CSF is consistent with viral meningitis

A
  • normal glucose 40-80
31
Q

tx of viral meningitis

A
  • self-limited, tx is symptomatic: analgesic, antipyretic
  • abx are started at presentation and discontinued once bacterial meningitis ruled out
32
Q

CSF WBC count expected in viral and bacteria meningitis

A
  • viral: < 500
  • bacterial: > 1,000
33
Q

CSF protein expected in viral and bacteria meningitis

A
  • viral: 15-45
  • bacterial: 100-500
34
Q

differentiate between meningitis and encephalitis

A
  • meningitis: preservation of cerebral function
  • encephalitis: abnormalities in brain function
    • can be blurred: meningoencephalitis
35
Q

define encephalitis

A
  • acute inflammation of brain
36
Q

what is primary infection encephalitis

A
  • due to viral invasion of CNS
    • neuronal involvement
37
Q

what is post infectious encephalitis (Acute disseminated encephalomyelitis)

A
  • immune mediated, no virus detection
  • neurons spared
  • typically occurs at initial infection is resolving
38
Q

what is the most common cause of fatal encephalitis

A
  • herpes simplex virus
39
Q

what is the most common cause of encephalitis

A
  • west nile virus
40
Q

photophobia and nuchal rigidity are rare with encephalitis but may be seen with

A

meningoencephalitis

41
Q

clinical presentation

  • fever
  • headache
  • AMS
  • Sz
  • focal neurological deficits (hemiparesis, CN palsies, inc DTR)
A

encephalitis

42
Q

encephalitis caused by west nile virus will present with

A
  • flaccid paralysis and rash
43
Q

diagnostic evaluation of encephalitis

A
  1. blood cultures x 2
  2. CBC, CMP
  3. CSF PCR for HSV-1, HSV-2, and enteroviruses
  4. IgM antibody testing for West nile virus
44
Q

imaging study of choice for encephalitis

A
  • MRI
    • temporal lobe changes suggestive of HSV
45
Q

tx of encephalitis

A
  • acyclovir
    • HSV is the most important to identify and treat
  • Sz prophylaxis and control
46
Q

two types of epidural abscess

A
  • intracranial (IEA)
  • spinal (SEA)
47
Q

two etiology types causing CNS abscess

A
  1. direct spread: otitis media, meningitis, head trauma
  2. hematogenous spread: pulmonary, skin, intraabdominal infection
48
Q

90% of CNS abscesses are caused by

A

bacteria

49
Q

immigrants can get cerebral abscess caused by

A
  • parasites
    • cysticercosis due to Taenia solium
50
Q

clinical presentation

  • usually nonspecific
  • unilateral headache
  • fever
  • nuchal rigidity
  • AMS
  • focal neurological deficits
  • Sz
A

cerebral/intracranial abscess

51
Q

diagnostic evaluation of CNS abscess

A
  • blood cultures x 2
  • CBC, CMP
52
Q

imaging of choice for CNS abscess

A
  • MRI
    • will show a ring-enhanced lesion
      • necrosis after 2 weeks
53
Q

treatment of CNS abscess

A
  • CT guided aspiration or surgical excision
  • abx empiric
    • 4-8 weeks
54
Q

imaging of choice for spinal epidural abscess

A
  • MRI - ASAP
    • neurologic changes can become permanent
55
Q

most common cause of spinal epidural abscess

A
  • staph aureus > 60%
    • consider MRSA
56
Q

diagnostic evaluation of spinal epidural abscess

A
  • blood cultures x 2
  • CBC with diff, CMP
57
Q

tx of spinal epidural abscess

A
  • CT guided aspiration or sugical excision
  • abx x 4-8 weeks
    • vancomycin +
      • ​ cephalosporin

clin med III final (7 decks)

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