CNS infections Flashcards
Which type of meningitis is associated with worse outcomes?
Bacterial
What are the three most common types of bacterial meningitis?
Haemophilus - most common, children <2 at greatest risk
meningococcal - children 2-18, increased risk associated with crowding (dorms)
pneumococcal - greater cognitive impairment
What are ways of bacteria spread to the meninges?
From an adjacent infected area (ears, sinuses)
From the environment (penetrating injury, congenital defect)
Through the bloodstream (hematogenous) - MOST COMMON
What is the primary cause of brain damage in bacterial meningitis?
Inflammation, which leads to tissue and vascular injury, septic thrombosis, and smaller infarcts
Which cranial nerve is most often impacted in meningitis?
VIII -auditory - can result in sensorineural hearing loss
CN defects are more common in children than adults
What is mortality rate of BM?
10%, down from near 90% since the development of antibiotics in the 50s
What are the most common neurobehavioral sequelae of BM?
Hearing loss (11%)
ID (4%)
Spasticity/paresis (4%)
Seizure disorders (4%)
Cognitive/behavioral issues are most common in children (78%)
What are the two most vulnerable age groups for BM?
Children < 5 y.o. and older adults (60+)
What is the biggest medical risk factor for BM?
Immunosuppression
Causes include treatment
HIV
Cystic fibrosis
Diabetes
What are risk factors for worse outcomes in children with BM?
Acute neurological complications (prolonged seizures, coma, bilateral hearing loss)
Low CSF glucose levels
<1 y.o. - worse language outcomes
Male gender - worse behavioral outcomes
What are symptoms of acute BM?
Sudden fever
Severe headaches
Nuchal rigidity (stiff neck)
What are symptoms of gradual BM?
Typically non-specific “flu-like” symptoms
What are common presenting symptoms of BM in children?
Hyperthermia, lethargy, anorexia/vomiting, respiratory distress, irritability, jaundice, bulging fontanelle (space between bones of skull where sutures are not fully formed in an infant), diarrhea, nuchal rigidity
What is the diagnostic method to confirm BM?
Lumbar puncture - look for bacteria, also red & white blood cells, high protein levels, and low glucose
Are CT and brain MRI useful in diagnosis of BM?
No - meningeal enhancement may be seen but absence dis not a rule out
What are academic consequences in children with BM?
More than twice as likely to require special education
More likely to repeat a grade
What are NP findings in adults with meningitis?
Attention problems, slowed processing speed, executive deficits
Sensorimotor problems - hearing loss, hemiparesis, cortical blindness, ataxia* (* - typically resolve)
Memory findings are mixed
What are NP findings in children with meningitis?
Lower IQ in those with acute complications
Attention problems (elevated ADHD symptoms)
Language problems in those with BM before 1 y.o.
Executive deficits below expectation but not impaired
Behavioral changes
What is aseptic meningitis?
Meningitis caused by viruses, fungi, and parasites
! Stuckey mentioned tuberculosis but it is caused by bacteria
What is the most common cause of aseptic meningitis?
Enteroviruses
Which type of meningitis if more common?
Viral
What are symptoms of VM?
Severe headache, fever, nausea, vomiting, still neck, rash, fatigue
Flu-like symptoms precede neurologic symptoms by about 48 hours
What diagnostic methods are used in VM?
LP and blood work to detect viral pathogens
Is there a specific treatment for VM?
No, treatment is supportive (rest, fluids, anti-inflammatory)
