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Neuro > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

4 Signs of increased ICP

A
  • papilledema
  • Abducens (6) palsy
  • bulging fontanelle
  • cushings reflex
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2
Q

List the cushings reflex triad

A
  • HTN
  • bradycardia
  • irregular respiration
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3
Q

Are Kernigs and Brudinskis sensitive or specific for meningitis?

A

-both are very specific but not sensitive (5%, 95%)

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4
Q

Which clinical meningitis sign is most sensitive?

A

-nuchal rigidity

but still not very sensitive, 30%

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5
Q

CNS infection- pertinent labs

A
  • CBC
  • Complete Chemistry
  • PT/PTT
  • HCG
  • blood + urine cultures
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6
Q

When is it appropriate to scan prior to LP?

A
  • localizing signs
  • AMS
  • seizures
  • signs of increased ICP
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7
Q

What are the uses of the four tubes drawn during LP?

A

1- glucose and protein
2- cell count
3- gram stain, routine culture
4- viral studieqs, VDRL

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8
Q

What should never be tested from tube 1 in LP?

A

-culture and gram stain, skin flora in tube one

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9
Q

How quickly is CSF normally replenished?

A

-half mL per minute

normal volume = 140 mL

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10
Q

Normal CNS glucose levels

A

2/3 serum glucose, 1/3 or less very sensitive for bacterial meningitis

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11
Q

How can protein levels be evaluated in traumatic tap?

A

-protein up 1 for every 700 RBCs

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12
Q

How many mononuclear WBCs are typically in CSF?

A

0-5

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13
Q

Proper position for LP opening pressure determination?

A

-lateral decubitus, not prone

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14
Q

What type of meningitis has normal opening pressure?

A

-fungal CAN be normal or low, other types at least slightly elevated

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15
Q

What type of meningitis has normal glucose?

A

-viral, all others have low glucose, esp bacterial

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16
Q

What type of meningitis has normal protein?

A

-viral, all others have high protein, esp bacterial

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17
Q

What type of meningitis involves RBCs in CSF?

A

-Bacterial

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18
Q

List the normal number of WBCs in CSF for each meningitis etiology:

A
  • bacterial: over 200
  • viral: 50-200
  • fungal: 30-50
  • TB: 20-30
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19
Q

Cell type predominant in CSF for bacterial, viral, fungal and TB meningitis

A

-mono except in bacterial = PMNs

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20
Q

Viral meningitis:

frequent bugs

A
  • adeno
  • entero
  • arbo
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21
Q

Viral meningitis:

  • typical months
  • typical length
A
  • summer

- week

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22
Q

Frequent bacterial meningitis bug across all age groups

A

-strep pneumo

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23
Q

Top 2 bugs in neonatal meningitis + empirical treatment

A
  • 1 GBS
  • 2 Listeria
  • amp & gent
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24
Q

Top 2 bugs in 1-23 month olds + empirical treatment

A

1- strep pneumo
2- n men
ceftriaxone + vanc

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25
Q

Top 2 bugs in 2-18 year olds + empirical treatment

A

1- n men
2- strep pneumo
(GBS, Listeria also possible)

ceftriax + vanc + amp

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26
Q

19-59 top 2 meningitis bugs + treatment

A

-strep
-n men
ceftriax + vanc

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27
Q

Top 2 bugs in elderly meningitis + empiric treatment

A
  • Strep pneumo
  • Listeria
  • ceftriax, vanc, amp
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28
Q

Treatment for GBS meningitis (2)

A

-amp
or
-pen G

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29
Q

Treatment for neisseria meningitis (2)

A

-amp
or
-ceftriaxone

**may add dexamethasone

30
Q

Strep pneumo meningitis treatment

A

-ceftriax + vanc if penicillin resistant

31
Q

Listeria treatment in meningitis

A

amp and gent

32
Q

Treatment for gram - meningitis

A

-ceftriaxone or cefotaxime

33
Q

Px for n meningitis

A

-rifampin 2 weeks or ceftriax one dose IM

34
Q

Long term effects of bacterial meningitis

A
  • hearing loss
  • learning disability
  • epilepsy
  • hydrocephalus
35
Q

Mortality rate encephalitis

A

10%

36
Q

Common encephalitis origins

A

HSV1
arboviruses (west nile, eastern equine)
enterovirus (polio)

37
Q

Nonviral causes of encehpalitis in the immunocompromised

A
  • toxoplasmosis

- aspergillosis

38
Q

When bacterial infections involve the brain they are called ____

A

cerebritis vs abscess depending on whether capsule exists

39
Q

At what CD4 count is AIDs patient at risk of encephalitis?

A

200

40
Q

Risks for encephalitis aside from immunosupression

A

-travel
-bats, mosquito exposure
(in endemic areas)

41
Q

Encehpalitis workup: how do labs differ from meningitis workup?

A

-send CSF for cytology to evaluate for cancer cells

42
Q

Basic lab added to encephalitis workup

A

UA

43
Q

Imaging most sensitive for diagnosing viral encephalitis

A

-T2 MRI.

44
Q

Treatment for HSV, VZV, EBV encehpalitis

A

IV acyclovir

45
Q

Treatment for CMV encephalitis

A

ganciclovir, foscarnet

46
Q

Treatment for lacrosse california encehpalitis

A

Ribaviron

47
Q

Viral encephalitis with highest number of neuro sequelae

A

eastern equine (80%)

48
Q

Otitis/mastoiditis:
how commonly do they cause abscess?
Where do they most commonly form abscess in brain?

A

cause of 33% abscesses

MC temporal/cerebeller

49
Q

Common otitis/mastoiditis organisms?

A
  • strep
  • bacteroides
  • pseudomonas
50
Q

Sinusitis:

  • what bugs are implicated
  • where might they form cerebral abscess?
A
  • staph aureus

- haemophilus

51
Q

How commonly are brain abscesses a result of hematogenous spread?

A

25%

52
Q

MC symptom of brain abscess?

A

-#1 headache

60% focal deficits, 35% seizure

53
Q

Typical antibiotics for abscess?

A

cephalosporin

metronidazole

54
Q

Neurosurg abscess drugs

A

ceftaz and vanc to cover staph and pseudomonas

55
Q

When should steroids be given for abscess?

A

only if there is significant edema

56
Q

MC cause subdural empyema

A

extension of sinus infection or meningitis

57
Q

Treatment for subdural empyema

A
  • burr hole + drainage

- cefotaxime + metronidazole

58
Q

Cause of epidural empyema

A 
#1 sx/skull fracture 
-also mastoiditis, sinusitis, otitis
59
Q

Treatment epidural empyema

A
  • drainage
  • vanc
  • metronidazole
60
Q

1 cause meningitis in AIDs patients

A

cryptococcus

61
Q

C. neoformans animal assc

A

pigeon soil –> inhaled –> blood –> meninges

62
Q

Stain for cryptococcus

A

india ink

63
Q

Treatment for cryptococcus

A

amphotericin

fluconazole

64
Q

At what CD4 count is toxoplasmosis a concern in HIV patients?

A

200

65
Q

Toxo:

How is diagnosis made?

A

MRI

66
Q

How is toxoplasmosis treated?

A

sulfadiazine

pyrimethamine + leucovorin

67
Q

What is toxo px for AIDs patients

A

TMP SMX daily until CD4 is greater than 200

68
Q

What part of the brain is most susceptible to toxo?

A

basal ganglia

69
Q

Bug assc with neurocysticercosis

A

T solium

70
Q

Dx neurocysticercosis

A

MRI/CT

71
Q

Treatment for neurocysticercosis

A
  • seizure treatment (no px until after 1st seizure)
  • steroids
  • albendazole

Neuro (15 decks)

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