CNS Infections

Question 1

Infection of various parts of the brain is referred to as an ________.

Whereas an infection of the spinal cord would be referred to as ________.

Answer 1

Encephalitis

Myelitis

Question 2

T/F: Infectious agents in the CNS are becoming more opportunistic

Answer 2

True

Question 3

__________ is an acute infection of the leptomeninges due to bacteria growing within the CSF

Answer 3

Meningitis

Question 4

Bacterial Meningitis can sometimes be a direct extension from infections where?

Answer 4

Mastoid
Sinuses
Skull

Question 5

In neonates, what bacteria are often responsible for bacterial meningitis?

Answer 5

Group B Streptococcus
Listeria
Gram-negative Rods

Question 6

In child and adults, what bacteria are often responsible for bacterial meningitis?

Answer 6

S. pneumoniae

N. meningitidis (Likely with Rash)

Question 7

What is the classic TRIAD of meningitis?

Answer 7

Fever
Nuchal Rigidity
Headache

Question 8

What are the most common focal abnormalities seen in meningitis patients?

Answer 8

Hemiparesis
Aphasia
Gaze Preference

(These are more commonly seen in pneumococcal meningitis)

Question 9

T/F: Bacterial Meningitis is NOT a medical Emergency

Answer 9

False

It is!

Question 10

What is the most essential portion of meningitis work up?

Answer 10

Lumbar Puncture for CSF analysis

Question 11

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?

Answer 11

Normal

No RBCs! Congrats on the champagne tap!

Question 12

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?

Answer 12

Abnormal

Acute Bacterial Meningitis

Question 13

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?

Answer 13

Abnormal

Acute Viral Meningitis

Question 14

If acute bacterial meningitis is high on your differential, what should be started prior to imaging or LP?

Answer 14

Empiric ABx

Goal: Shortest Door-to-ABx time

Question 15

If a CT shows cerebral edema, lesions, mass effect, or ventriculomegaly what may be contraindicated?

Answer 15

LP

Question 16

What lab should ALWAYS be drawn prior to starting ABx?

Answer 16

Blood Cultures

Question 17

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?

Answer 17

Dexamethasone

Ceftriaxone
Vancomycin
Ampicillin

Question 18

How can you differentiate between acute meningitis and subacute/chronic meningitis in terms of onset?

Answer 18

Acute: Hours to days

Subacute/Chronic: Weeks to months

Question 19

What organisms are commonly associated with subacute/chronic meningitis?

Answer 19

TB
Ccryptococcosis (immunocompromised)
Syphilis
Lyme

Question 20

Chronic meningitis due to TB, would show __________ inflammation near the base of the brain

Answer 20

Granulomatous

Question 21

What is the most common cause of sporadic viral encephalitis?

Answer 21

HSV 1

Question 22

HSV 1 commonly effects which lobe of the brain?

Answer 22

Temporal

Question 23

What is a severe complication of HSV encephalitis?

Answer 23

Hemorrhagic necrosis

Question 24

If a lesion on the brain showed contrast enhancement, what would this indicate?

Answer 24

A breakdown of the BBB

Question 25

What is the treatment of choice for HSV 1 encephalitis?

Answer 25

Acyclovir