CNS Infections Flashcards
Most likely diagnosis:
- stiff neck
- photophobia
- meningismus
Meningitis
Most likely diagnosis:
- fever
- headache
- confusion
Encephalitis
MCC meningitis in elderly, neonates, and IC pts?
Listeria
Cause of meningitis after recent neurosurgery?
Staphylococcus
Cause of meningitis in AIDS pt w/ CD4
Cryptococcus
Cause of meningitis in camper with rash shaped like a target, joint pain, and facial palsy?
Lyme disease
Cause of meningitis in camper, rash moving from risks to trunk
RMSF
Cause of meningitis in pulmonary TB pt?
TB
Cause of meningitis in pt with no specific presentation?
viral
Cause of meningitis in adolescent w/ petechial rash?
Neisseria
Best initial test/most accurate test for meningitis?
LP
Characteristics of CSF of pt with bacterial meningitis?
HIGH neutrophils/cell count
ELEVATED protein level
DECREASED glucose level
Sometimes positive stain and culture
Characteristics of CSF of pt with viral meningitis?
LOW cell count
NORMAL protein level
NORMAL glucose level
Negative stain and culture
Characteristics of CSF of pt with Cryptococcus, Lyme, or Rickettsia meningitis?
LOW cell count
possibly elevated protein level
possibly decreased glucose level
Negative stain and culture
Characteristics of CSF of pt with TB meningitis?
LOW cell count
MARKEDLY ELEVATED protein level
Possibly decreased glucose level
Negative stain and culture
What is a specific characteristic in CSF of TB meningitis?
Markedly elevated protein level in CSF
If pt has focal findings, seizures, papilledema, or confusion with diagnosis of meningitis, what is the first initial test?
Head CT
If Listeria is possible cause of meningitis, what is added to treatment regimen?
Ampicillin
All close contacts of a patient treated for N. meningitis meningitis are treated with what abx?
rifampin, cipro, or ceftriaxone
MC neuro deficit of untreated meningitis
8th CN deficit or deafness
MCC of encephalitis
HSV
Most accurate test for HSV encephalitis
PCR of CSF
1st line Tx for HSV encephalitis
acyclovir
1st line Tx for Acyclovir-resistant encephalitis?
Foscarnet
What is a major side effect of acyclovir?
renal toxicity
What is the most accurate diagnostic test for TB meningitis?
acid-fast stain and culture on 3 high-volume lumbar punctures
What is the most accurate diagnostic test for Lyme and Rickettsia meningitis?
specific serology testing, ELISA, Western blot, and PCR
What is the most accurate diagnostic test for Cryptococcus meningitis?
India ink (60-70% sensitivity) Cryptococcal Ag (>95% sensitive and specific)
What is the most accurate diagnostic test for viral meningitis?
diagnosis of exclusion
