CNS Infections Flashcards
Infection of various parts of the brain is referred to as an ________.
Whereas an infection of the spinal cord would be referred to as ________.
Encephalitis
Myelitis
T/F: Infectious agents in the CNS are becoming more opportunistic
True
__________ is an acute infection of the leptomeninges due to bacteria growing within the CSF
Meningitis
Bacterial Meningitis can sometimes be a direct extension from infections where?
Mastoid
Sinuses
Skull
In neonates, what bacteria are often responsible for bacterial meningitis?
Group B Streptococcus
Listeria
Gram-negative Rods
In child and adults, what bacteria are often responsible for bacterial meningitis?
S. pneumoniae
N. meningitidis (Likely with Rash)
What is the classic TRIAD of meningitis?
Fever
Nuchal Rigidity
Headache
What are the most common focal abnormalities seen in meningitis patients?
Hemiparesis
Aphasia
Gaze Preference
(These are more commonly seen in pneumococcal meningitis)
T/F: Bacterial Meningitis is NOT a medical Emergency
False
It is!
What is the most essential portion of meningitis work up?
Lumbar Puncture for CSF analysis
Following an LP the CSF results show……
[-] RBCs [-] WBCs [-] Neutrophils [-] Monocytes [-] Lymphocytes Protein: WNL Glucose: WNL
Is this abnormal or normal?
If abnormal, what is the diagnosis?
Normal
No RBCs! Congrats on the champagne tap!
Following an LP the CSF results show……
[-] RBCs [+] WBCs [+] Neutropphils [-] Monocytes [-] Lymphocytes Protein: Increased Glucose: Decrease
Is this abnormal or normal?
If abnormal, what is the diagnosis?
Abnormal
Acute Bacterial Meningitis
Following an LP the CSF results show……
[+] RBCs [+] WBCs [+] Neutrophils [+] Monocytes [+] Lymphocytes Protein: Borderline High Glucose: WNL
Is this abnormal or normal?
If abnormal, what is the diagnosis?
Abnormal
Acute Viral Meningitis
If acute bacterial meningitis is high on your differential, what should be started prior to imaging or LP?
Empiric ABx
Goal: Shortest Door-to-ABx time
If a CT shows cerebral edema, lesions, mass effect, or ventriculomegaly what may be contraindicated?
LP
What lab should ALWAYS be drawn prior to starting ABx?
Blood Cultures
A patient presents with high fever, neck stiffness, and a severe headache. Physical examination is significant for nuchal rigidity, + brudzinski’s, and no FNDs.
Blood cultures and labs are drawn immediately.
What medications are you starting immediately (before imaging or LP) as bacterial meningitis is number one on your differential?
Dexamethasone
Ceftriaxone
Vancomycin
Ampicillin
How can you differentiate between acute meningitis and subacute/chronic meningitis in terms of onset?
Acute: Hours to days
Subacute/Chronic: Weeks to months
What organisms are commonly associated with subacute/chronic meningitis?
TB
Ccryptococcosis (immunocompromised)
Syphilis
Lyme
Chronic meningitis due to TB, would show __________ inflammation near the base of the brain
Granulomatous
What is the most common cause of sporadic viral encephalitis?
HSV 1
HSV 1 commonly effects which lobe of the brain?
Temporal
What is a severe complication of HSV encephalitis?
Hemorrhagic necrosis
If a lesion on the brain showed contrast enhancement, what would this indicate?
A breakdown of the BBB
What is the treatment of choice for HSV 1 encephalitis?
Acyclovir
