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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
Bacterial meningitis - Pathology - Antibiotics in the immediate acute stages
Might increase release of endotoxins - you are getting rid of some endotoxins but also letting more come
26
Bacterial meningitis - Pathology - Inflammation results in
``` CSF blockage Communication hydrocephalus (reuptake) Obstructive hydrocephalus (block) Cortical ischemia Inc ICP ```
27
Bacterial meningitis - Pathology - Communication hydrocephalus (reuptake)
The system is not taking up the CSP as it should so it is sitting there and not being taken up
28
Bacterial meningitis - Pathology - Obstructive hydrocepahlus (block)
More common kind where there is a blockage of the CSF pathways
29
Bacterial meningitis - Pathology - Cortical ischemia results
Because the vascular system is blocked if it is severe enough
30
Bacterial meningitis - increase ICP and cerebral perfusion pressures
When we have an increase in ICP we start to lose brain perfusion
31
Bacterial meningitis - Diagnosis
CSF changes | Clinical tests
32
Bacterial meningitis - Diagnosis - CSF changes
Bacterial agent Glucose drops Inc WBCs - mostly PMNs Elevated protein
33
Bacterial meningitis - Clinical tests
Kernigs (90/90) | Brudznski's - passive neck flexion with hip and knee flexed
34
Bacterial meningitis - Contraindications for lumbar puncture
Space occupying intracranial lesions or obstructive hydrocephalus Bleeding disorders Spinal epidural abscess
35
Controversy with lumbar puncture - Bacterial meningitis
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
Bacterial meningitis - Lumbar puncture - complications
Headache Meningitis (direct inoculation) Impalement of nerve roots
37
CSF analysis - opening pressure - Bacterial vs. Viral
B - normal or high | V - normal
38
CSF analysis - WBC - B vs. V
B - 1,000 to 10,000 inc. | V - less than 300 dec
39
CSF analysis - PMN % - B vs. V
B - over 80 | V - less then 20
40
CSF analysis - Mononuclear forms - B vs. V
B - PMN | V - Lymphocytes
41
CSF analysis - RBC count - B vs. V
B - slight increase | V - Normal
42
CSF analysis - Protein - B vs. V
B - Very high (100 to 500) | V - Normal
43
CSF analysis - Glucose - B vs. V
B - Less than 40 | V - Normal
44
CSF analysis - Gram stain - B vs. V
B - 60 to 90% positive | V - negative
45
CSF analysis - Culture % positive - B vs. V
B - 70 to 85 | V - 25
46
Bacterial meningitis - Clinical features
``` Fever (higher with bacterial) HA Nuchal rigidity Neck and/or lumbar pain Vomit, lethargy, photophobia Papilledema Focal neuro s/s particularly CNs ```
47
Bacterial meningitis - Treatment
Antibiotics Focus on improving capillary integrity and dec edema Steroid
48
Bacterial meningitis - Prognosis - Streptococcus pneumoniae
Person to person transmission Nasopharynx primary site of colonization 20% mortality
49
Bacterial meningitis - Prognosis - Hemophilus Influenzae
Upper resp. tract Fatality 6% in childre, higher in adults Vaccination now
50
Risk factors - Bacterial meningitis - Hemophilic influenzae
``` Head trauma Neurosurgery Paranasal sinusitis Otitis media CSF leak ```
51
Bacterial meningitis - Prognosis - Group B streptococcus
Neonatal Transmission via genital tract 5-7% mortality
52
Bacterial meningitis - Prognosis - Neisseria Meningitidis
Nasopharynx primary site of colonization Rapid progression Petechial rash trunk and low body 3% mortality
53
Bacterial meningitis - Prognosis - listeria monocytogenes
Contaminated food | 15% mortality
54
Viral (Aseptic) Meningitis
Most common type of meningitis Tends to be self limiting Tends to occur in outbreaks HA, low grade fever, stiff neck
55
Chronic Meningitis
Fungus Virus (HIV) Bacteria
56
Lyme Disease
Tick borne disorder Systemic infection Borrelia Burgdorferi Integument effected first
57
Lyme disease - s/s
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
Encephalitis - Herpes Simplex Virus s/s
Fever, HA, Bx abnormalities or personality changes Seizures and focal neuro deficits often occur Initial sx often mild
59
Encephalitis - Herpes Simplex Virus - prognosis
Fair to poor (usually leaves residual neurological deficits)
60
Encephalitis - Arthropod borne ecephalitis - s/s
``` 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
Encephalitis - St. Louis Encephalitis
Mosquito vector | Most common of epidemics - can cause coma and/or death
62
Encephalitis - Rabies
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
Brain abscess - causes
Direct implantation Extension from other foci Hematogenous spread
64
Brain abscess - risk factors
``` Immunosuppression Cytotoxic chemotherapy (immunosuppression) Systemic infection (HIV) ```
65
Brain abscess - pathology
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
Brain abscess - diagnosis
``` Lumbar puncture often contraindicated Inc WBC, protein levels Normal glucose No pathogen unless abscess rupture MRI is standard ```
67
brain abscess - clinical features
Depends on location of abscess | s/s of increased ICP
68
Brain abscess - prognosis
Depends on location of abscess 25% mortality rate 50% residual neurological problems
69
Brain abscess - tx
Surgical drainage/excision Antibiotics Steroids
70
Subdural and Epidural Empyema - Locations
Subdural - Between the dura and arachnoid | Epidural - external to dura
71
Subdural and Epidural Empyema - Causes
Head injuries (Epidural) Osteomyelitis (most common) Sinus infections
72
Subdural and Epidural Empyema - Clinical features/Tx
Much like abscess Surgical drainage Antibiotics
73
Latent infections of the CNS - definition
Unconventional transmissible agents (mostly prions) | Results in spongiform encephalopathy
74
Latent infections of the CNS - Creutzfeldt Jokob Disease impacts what lobes
Frontal and parietal lobes
75
Latent infections of the CNS - Creutzfeldt Jokob Disease - s/s
Initial presentation is often dementia | Myoclonic mvmnts, seizures, rigidity
76
Latent infections of the CNS - Creutzfeldt Jokob Disease - prognosis
3 months - 3 years | Will result in death in about 3 years or so
77
Latent infections of the CNS - Subacute scelorsing panecephalitis (SSPE)
Both white and grey matter | Demyelination and inflammation
78
Latent infections of the CNS - Subacute scelorsing panecephalitis (SSPE) - s/s
Infection usually at early age (less than 2) Evidence rubeola Ataxia, myoclonic mvmnts Mental deterioration
79
Latent infections of the CNS - Kuru s/s
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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