CNS Infections Flashcards
What are the Meningeal signs?
- Nuchal rigidity
- Kernig sign
- Brudzky’s sign
What is nuchal rigidity?
Pt supine, try to flex neck & meet resistance
What is Kernig sign?
Flex hip to 90° & extend the knee→ causes pain
What is Brudzky’s sign?
Pt supine, flex neck & pt pulls legs up (bend @ hips & knees)
What is a fever?
T >99.2° in AM or T>99.9° in PM
What are the Inc ICP signs?
- HA worse supine & in PM
- N/V
- Lethargic to coma
- Pailledema
- Lateral rectus pasly: estropia
- Blurred vision
- Cushings triad
What is Cushing’s Triad?
HTN, bradycardia & Resp irreg
What is the hx of Aseptic meningits (viral)?
- HA
- Neck pain & stiffness
- Acute or subacute onset
- Malaise
- N/V/D
- Hx of preceding URI
- Check hx of NSAID use
What are the PE findings of Aseptic meningitis (viral)?
- Fairly normal mental status or mildy lethargic or irritable
- Normal neuro exam
- nuchal rigidity
- photphobia
What are the CSF findings in Aseptic meningitis?
- Opening pressure mildly-mod inc
- Clear, colorless
- WBC count normal or inc
- Protein inc
- Glucose normal
- Culture neg
What are the PE findings of Bacterial meningitis?
- Acute or subacute
- Fever & HA
- Neck pain
- N/V
- Photophobia
- Altered mental status
- Seizures
When should a CT scan be performed prior to an LP in bacterial meningitis?
- Immunocompromised pt
- Focal neuro signs
- Altered mental status
- Papilledema
- Hx of recent head trauma
- Seizures
What are the CSF findings of bacterial meningitis?
- Elevated opening pressure
- Elevated WBC count w/ neutrophils
- Low glucose
- gram stain
When should empirical antimicrobial therapy be started in bacterial meningitis?
As soon as the dx is suspected
What are the PE findings of Viral encephalitis or meningoencephaltis?
- More profound mental status changes
- More freq seizures, CN ABN & focal neuro deficits
What are the Tech features of viral encephalitis or meningoencephalitis?
- Brain imaging before LP
- MRI + in HSV encephalitis
What are the PE findings of Subacute Meningitis?
- Subacute or chronic
- Stiff neck
- Low grade fever
- Lethargy & mental status changes
- Freq hx of IC status
- Night sweats
- Pulmonary sx
- CN ABN
What are the CSF findings of subacute meningitis (fungal or TB)?
- Elevated opening pressure
- Lymphocytic pleocytosis
- Inc protein
- Low glucose
- Acid fast or TB culture
- India ink & + cryptococcus capusular Ag in neofroman meningitis
What are the sx of Brain abscess?
- Subacute or gradual
- HA MC presenting sx
- Focal neuro sx & seizures common
- Sx get progressively worse
What is the hx of Brain abscess?
Preceding sinus, dental or ear infections, mastoidits, pulmonary infections or recent dental or neurosurgical procedures
What are the PE findings of brain abscess?
- Fever in <50% of time
- Focal neuro deficits are common & depend on abscess location
What is the most sensitive imaging for Brain abscess?
MRI w/ & w/o contrast
What is the duration of SC abscess?
Subacute or gradual
What do SC abscess follow?
Brain abscess w/ hematogenous spread to SC in epidural area or spinal surgery or trauma
What are the PE findings of SC abscess?
- Poly-radicular findings
- Myelopathic findings if lesion enroaches on SC
- Fever absent
What are the Tech features of SC abscess?
- MRI is best–epidural mass found
- Needle aspiration reveals suppurative process
- Organism ID on bx
What is the tx of SC abscess?
ABX base on organism or surgical decompression
