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Semester 5 PMNM Exam 7 > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

CNS is ___ ____ against infection

A

well protected - has mechanical and immunological barriers

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2
Q

Brain - immune response

A

Brain has limited immune responses once infection occurs

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3
Q

Brain - limited compliance to acute infections therefore

A

Permanent damage or death can occur quickly

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4
Q

Brain - chronic infections

A

Cause significant displacement with few s/s
Chronic infections cause s/s that mimic other things so hard to diagnose until there is significant displacement of brain structures

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5
Q

Various pathogens are responsible - name them

A

Bacteria
Viruses
Prions
Fungi

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6
Q

CNS infection - define

A

Inflammation of structures within the CNS as a result of a pathogen

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7
Q

Meningitis - define

A

Inflammation of the pia and arachnoid in the subarachnoid space

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8
Q

Encephalitis - define

A

inflammation of the brain parenchyma

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9
Q

Empyema - define

A

Accumulation of pus in the epidural or subdural spaces

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10
Q

Difference between bacterial and viral inflammatory response

A

Bacterial infection has a bigger inflammatory response than viral

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11
Q

Abscess or Granuloma - definition

A

Localized inflammation of the brain or spinal cord parenchyma

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12
Q

Myelitis - definition

A

Inflammation of the spinal cord parenchyma

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13
Q

Encephalomyelitis - define

A

inflammation of the brain and spinal cord

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14
Q

Ependymitis - define

A

inflammation of the ventricles and ventricular lining

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15
Q

Routes of entry or spread

A

Hematogenous spread
Direct inoculation
Direct spread/extension
Spread of viruses along nerves

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16
Q

Bacterial meningitis AKA

A

septic meningitis

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17
Q

Bacterial meningitis - what is often the primary clue of which bacteria

A

The age of onset

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18
Q

Bacterial meningitis - what is the most common route

A

Hematogenous (blood system spread)

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19
Q

Bacterial meningitis - Other routes that are common

A

congenital defects

acquired

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20
Q

Bacterial meningitis - Pathogen if age less than 3 months

A

Group B strep
E coli
Listeria
S pneumoniae

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21
Q

Bacterial meningitis - Pathogen if age 3 months to 50 years

A

S pneumoniae
Neisseria meningitidis
H influenza

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22
Q

Bacterial meningitis - Pathogen - greater than 50 years

A

S pneumoniae

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23
Q

Bacterial meningitis - Pathogen - or impaired cellular immunity

A

L monocytogenes

Gam - bacilli

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24
Q

Bacterial meningitis - Pathology

A

1 Dramatic loss of capillary integrity secondary to release of endotoxins
2 Purulent rxn with polymorphonuclear leukocytes and necrosis
3 Vascular occlusion - cerebral edema

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25
Q

Bacterial meningitis - Pathology - Antibiotics in the immediate acute stages

A

Might increase release of endotoxins - you are getting rid of some endotoxins but also letting more come

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26
Q

Bacterial meningitis - Pathology - Inflammation results in

A 
CSF blockage 
Communication hydrocephalus 
(reuptake)
Obstructive hydrocephalus (block) 
Cortical ischemia 
Inc ICP
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27
Q

Bacterial meningitis - Pathology - Communication hydrocephalus (reuptake)

A

The system is not taking up the CSP as it should so it is sitting there and not being taken up

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28
Q

Bacterial meningitis - Pathology - Obstructive hydrocepahlus (block)

A

More common kind where there is a blockage of the CSF pathways

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29
Q

Bacterial meningitis - Pathology - Cortical ischemia results

A

Because the vascular system is blocked if it is severe enough

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30
Q

Bacterial meningitis - increase ICP and cerebral perfusion pressures

A

When we have an increase in ICP we start to lose brain perfusion

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31
Q

Bacterial meningitis - Diagnosis

A

CSF changes

Clinical tests

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32
Q

Bacterial meningitis - Diagnosis - CSF changes

A

Bacterial agent
Glucose drops
Inc WBCs - mostly PMNs
Elevated protein

33
Q

Bacterial meningitis - Clinical tests

A

Kernigs (90/90)

Brudznski’s - passive neck flexion with hip and knee flexed

34
Q

Bacterial meningitis - Contraindications for lumbar puncture

A

Space occupying intracranial lesions or obstructive hydrocephalus
Bleeding disorders
Spinal epidural abscess

35
Q

Controversy with lumbar puncture - Bacterial meningitis

A

If ICP elevated a lot, typically won’t do it because you will release pressure in that area but also allow more pressure to go to that spot - you have given it a new pressure opening

36
Q

Bacterial meningitis - Lumbar puncture - complications

A

Headache
Meningitis (direct inoculation)
Impalement of nerve roots

37
Q

CSF analysis - opening pressure - Bacterial vs. Viral

A

B - normal or high

V - normal

38
Q

CSF analysis - WBC - B vs. V

A

B - 1,000 to 10,000 inc.

V - less than 300 dec

39
Q

CSF analysis - PMN % - B vs. V

A

B - over 80

V - less then 20

40
Q

CSF analysis - Mononuclear forms - B vs. V

A

B - PMN

V - Lymphocytes

41
Q

CSF analysis - RBC count - B vs. V

A

B - slight increase

V - Normal

42
Q

CSF analysis - Protein - B vs. V

A

B - Very high (100 to 500)

V - Normal

43
Q

CSF analysis - Glucose - B vs. V

A

B - Less than 40

V - Normal

44
Q

CSF analysis - Gram stain - B vs. V

A

B - 60 to 90% positive

V - negative

45
Q

CSF analysis - Culture % positive - B vs. V

A

B - 70 to 85

V - 25

46
Q

Bacterial meningitis - Clinical features

A 
Fever (higher with bacterial)
HA
Nuchal rigidity
Neck and/or lumbar pain
Vomit, lethargy, photophobia
Papilledema 
Focal neuro s/s particularly CNs
47
Q

Bacterial meningitis - Treatment

A

Antibiotics
Focus on improving capillary integrity and dec edema
Steroid

48
Q

Bacterial meningitis - Prognosis - Streptococcus pneumoniae

A

Person to person transmission
Nasopharynx primary site of colonization
20% mortality

49
Q

Bacterial meningitis - Prognosis - Hemophilus Influenzae

A

Upper resp. tract
Fatality 6% in childre, higher in adults
Vaccination now

50
Q

Risk factors - Bacterial meningitis - Hemophilic influenzae

A 
Head trauma
Neurosurgery
Paranasal sinusitis
Otitis media 
CSF leak
51
Q

Bacterial meningitis - Prognosis - Group B streptococcus

A

Neonatal
Transmission via genital tract
5-7% mortality

52
Q

Bacterial meningitis - Prognosis - Neisseria Meningitidis

A

Nasopharynx primary site of colonization
Rapid progression
Petechial rash trunk and low body
3% mortality

53
Q

Bacterial meningitis - Prognosis - listeria monocytogenes

A

Contaminated food

15% mortality

54
Q

Viral (Aseptic) Meningitis

A

Most common type of meningitis
Tends to be self limiting
Tends to occur in outbreaks
HA, low grade fever, stiff neck

55
Q

Chronic Meningitis

A

Fungus
Virus (HIV)
Bacteria

56
Q

Lyme Disease

A

Tick borne disorder
Systemic infection Borrelia Burgdorferi
Integument effected first

57
Q

Lyme disease - s/s

A

Fatigue, HA, fever, neck stiffness, jt and mm pain, sore throat, nausea
Neuo s/s up to 1- weeks after the start of the infection

58
Q

Encephalitis - Herpes Simplex Virus s/s

A

Fever, HA, Bx abnormalities or personality changes
Seizures and focal neuro deficits often occur
Initial sx often mild

59
Q

Encephalitis - Herpes Simplex Virus - prognosis

A

Fair to poor (usually leaves residual neurological deficits)

60
Q

Encephalitis - Arthropod borne ecephalitis - s/s

A 
West nile disease
Majority asymptomatic 
20%  will experience fever, HA, backache, myalgia, anorexia - lasting 3 to 6 days
50% develop rash, lymphadenopathy 
2% severe illness
61
Q

Encephalitis - St. Louis Encephalitis

A

Mosquito vector

Most common of epidemics - can cause coma and/or death

62
Q

Encephalitis - Rabies

A

Infected animals
Prevented by vaccination after exposure but before s/s start
Once encephalitis has begun, there is no effective tx and death is practically certain

63
Q

Brain abscess - causes

A

Direct implantation
Extension from other foci
Hematogenous spread

64
Q

Brain abscess - risk factors

A 
Immunosuppression
Cytotoxic chemotherapy (immunosuppression)
Systemic infection (HIV)
65
Q

Brain abscess - pathology

A

Localized infection with inflammation and tissue necrosis
Inflammatory response begins a fibrosis process that encircles the area of necrosis
Area is walled off and edema surrounds it

66
Q

Brain abscess - diagnosis

A 
Lumbar puncture often contraindicated 
Inc WBC, protein levels
Normal glucose
No pathogen unless abscess rupture
MRI is standard
67
Q

brain abscess - clinical features

A

Depends on location of abscess

s/s of increased ICP

68
Q

Brain abscess - prognosis

A

Depends on location of abscess
25% mortality rate
50% residual neurological problems

69
Q

Brain abscess - tx

A

Surgical drainage/excision
Antibiotics
Steroids

70
Q

Subdural and Epidural Empyema - Locations

A

Subdural - Between the dura and arachnoid

Epidural - external to dura

71
Q

Subdural and Epidural Empyema - Causes

A

Head injuries (Epidural)
Osteomyelitis (most common)
Sinus infections

72
Q

Subdural and Epidural Empyema - Clinical features/Tx

A

Much like abscess
Surgical drainage
Antibiotics

73
Q

Latent infections of the CNS - definition

A

Unconventional transmissible agents (mostly prions)

Results in spongiform encephalopathy

74
Q

Latent infections of the CNS - Creutzfeldt Jokob Disease impacts what lobes

A

Frontal and parietal lobes

75
Q

Latent infections of the CNS - Creutzfeldt Jokob Disease - s/s

A

Initial presentation is often dementia

Myoclonic mvmnts, seizures, rigidity

76
Q

Latent infections of the CNS - Creutzfeldt Jokob Disease - prognosis

A

3 months - 3 years

Will result in death in about 3 years or so

77
Q

Latent infections of the CNS - Subacute scelorsing panecephalitis (SSPE)

A

Both white and grey matter

Demyelination and inflammation

78
Q

Latent infections of the CNS - Subacute scelorsing panecephalitis (SSPE) - s/s

A

Infection usually at early age (less than 2)
Evidence rubeola
Ataxia, myoclonic mvmnts
Mental deterioration

79
Q

Latent infections of the CNS - Kuru s/s

A

Four tribe in new guinea
Intention tremor, slurring of speech, chorea, dementia
Death within 24 months

Semester 5 PMNM Exam 7 (7 decks)

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