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Neuro. CM3 > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Name of two leptomeninges:

A

Arachnoid and Pia mater

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2
Q

What has lead to the decrease of meningitis rates?

A

Conjugate vaccines

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3
Q

Where does meningitis infection take place?

A

Subarachnoid space - No immune protection here

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4
Q

Organism that causes highest mortality of meningitis:

A

S. pneumoniae - 20%

*Droplet spread

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5
Q

Organism with <10% mortality:

A

N. meningitidis

*Intimate contact

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6
Q

Organism with 5% mortality:

A

H. flu

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7
Q

Contagious spread from rarer adjacent spreads: (3)

A

OM or sinusitis (rare)
Trauma or Post-op infection
Indwelling devices (CSF shunts)

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8
Q

What causes leaking of albumin and vasogenic brain edema?

A

LPS on gram negative and cell wall on gram positive –> inflammation –> leaky BBB

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9
Q

If a patient is immunosuppressed or is on low dose steroids (vasculitis, RA, transplant) they have what organism:

A

Cryptococcus neoformans

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10
Q

TB infection can cause:

A

Chronic meningitis

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11
Q

Anatomic or functional asplenia exposes you to (3):

A

The three encapsulated organisms that cause meningitis: S. pneumonia, N. meningitidis and H. flu

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12
Q

Pregnant women may have what bug:

A

L. monocytogenes (listeria)

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13
Q

Facial or skull trauma may cause for you to get this bug:

A

Staphylococcus species

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14
Q

Children are at risk for meningitis from what bug:

A

S. pneumonia that is penicillin-resistant

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15
Q

Acute meningitis develops within:

A

Hours to days

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16
Q

Subacute meningitis develops over:

A

More than one week

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17
Q

What is subacute meningitis usually caused by? (3)

A

Mycobacterium, fungi or B. burgdorgeri (Lymes)

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18
Q

Chronic meningitis usually lasts: months to years and is causes by:

A

TB or Syphilis (T. pallidum)

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19
Q

Meningioencephalitis involves both the leptomeninges and the brain parenchyma. Causes by (2):

A

HSV or arbovirus (mosquito > tick)

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20
Q

Seizing is a big problem in what category of meningitis?

A

Meningoencephalitis

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21
Q

What is parameningeal infection?

A

Abscess, tumor that mimics symptoms of meningitis

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22
Q

Pre-term - 1 month: Causative bacterial agent is (3):

A

S. agalactiae (GBS)*
E. coli
Listeria

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23
Q

Over 1 month - 50 years: Causative bacterial agent is (3):

**Vaccination offers protection

A

S. pneumonia and N. meningitidis

*H. flu is rare

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24
Q

What two viruses causes 95% of pediatric meningitis:

A

Arboviruses
Enteroviruses
*ASEPTIC

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25
Q

The 4 medications that can cause aseptic meningitis:

A
  • TMP-SMX
  • Ibuprofen
  • Metronidazole
  • Lamotrigine - Bipolar
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26
Q

If you think you have a drug induced meningitis syndrome what do you do?

A

Stop medication, re-test the CSF

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27
Q

___ meningitis is most common

A

Viral

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28
Q

The signs and symptoms of meningitis are most often caused by:

A

The immune system not the bug itself

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29
Q

CN palsies possible with meningitis

A

4, 6, 7

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30
Q

Symptoms of meningitis (6):

A
  • HA
  • Fever
  • N/V
  • Photophobia
  • Increased ICP - Brady, HTN, papilledema
  • Seizures/CN palsies
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31
Q

The Kernig and Brudzinski test are:

A

Not sensitive but are highly specific

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32
Q

Range or the Glascow coma scale:

A

3 - Lowest (bad news)

15 - Highest

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33
Q

What is purpura fulminans

A

Mengococcemia - Starts as URI symptoms and progresses to the rash (can be in a day)

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34
Q

Tests you order for Meningitis (5) 3C’s, B, L:

A
  • CBC with diff
  • CMP
  • Coagulation and platelets if alcoholic
  • Blood cultures
  • Lumbar puncture (4 tubes)
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35
Q

What are the four tubes for the lumbar puncture:

A
  1. Glucose and protein
  2. Cell count with differential
  3. GS and bacterial
  4. Repeat and future studies
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36
Q

What is the VDRL test?

A

Neurosyphilis

37
Q

What would you order to test for TB?

A

AFB stain

38
Q

What would you order if you suspected crypto coccus neoformans?

A

Cryotococcal antigen

39
Q

When do you not do a LP?

A

If someone comes in with back pain AND meningitis symptoms - could be an epidural abscess

40
Q

Medication for viral meningitis:

A

Acyclovir

41
Q

What is the ME panel?

A

Tests meningitis and encephalitis (yeast - crypto neoformans), viruses and bacteria)

42
Q

What will be high on labs if bacterial meningitis?

A
  • High opening PSI
  • High cell count - PMNs
  • High protein
43
Q

What will be high on labs if viral meningitis?

A
  • High Lymphs

**All else is LOW

44
Q

Strep pneumoniae morphology:

A

Gram positive lanceolate diplococci

45
Q

Neisseria meningitidis morphology:

A

Gram negative coffee bean diplococci

46
Q

H. Flu morphology:

A

Brat-like gram negative rods/coccobacilli

47
Q

Listeria Monocytogenes morphology:

A

Gram positive SMALL rod

48
Q

If you do an LP and get pus:

A

Epidural abscess - BAD

49
Q

Most common SE of a LP (10 - 30% of patients):

A

Headache - Frontal/occipital (will improve in 12-24 hours)

50
Q

HA post LP improvement with what position:

A

HA improves in the supine position

51
Q

Treatment of post LP HA: (2 steps):

A
  1. Bed rest + oral analgesics (opioids if necessary)

2. Epidural blood patch - autologous blood injected at site of LP (volume replacement)

52
Q

CT SCANS ARE ___for meningitis treatment

A

Not needed for meningitis right away and delay treatment

53
Q

It takes ___ hours before the ABX for meningitis would affect a LP result

A

6 hours

54
Q

If you get a head CT before a LP, also get __

A

Two sets of blood cultures and start treatment immediately (2 IVs)

55
Q

Who should get a CT before a LP? (6) HANNIP

A

HANNIP:

  • History of stroke/lesion
  • Abnormal level of consciousness
  • New onset seizure (within 1 week)
  • Neuro déficit - dilated pupil, gaze palsy etc.
  • Immunocompromised
  • Papilledema
56
Q

What is started ASAP for a patient with meningitis in the ED?

A
  • 1 shot dexamethasone

- Vanco. + 3rd gen cephalosporin (ceftriaxone)

57
Q

Isolation for meningitis:

A

Droplet

58
Q

ABX for meningitis must have these characteristics (3):

A
  • Bacteriocidal
  • ABX that penetrates the CSF
  • Go after MRSA
59
Q

If you think the patient has meningitis from listeria, add what medication?

A

Ampicillin

60
Q

If steroids or given, how should they be given?

A

WITH or slightly before the ABX

- 0.15 mg/kg IV q6 hours x 4 days

61
Q

How long do you treat for? Meningitis –> Pneumococcal –> Listeria

A
  1. Meningococcal: 5 - 7 d
  2. Pneumococcal: 10 - 14 d
  3. Listeria: Minimum of 21 d
62
Q

Three vaccines available to prevent meningitis:

A
  1. Pneumococcal
  2. HIB
  3. Meningococcal
63
Q

MENGIOCOCCAL ONLY: Treatment for those exposed to oral secretions or respiratory droplets >8 hours duration before symptom onset (3 options):

A
  1. Ceftriaxone (250 mg IM x1)
  2. Ciprofloxacin (500 mg PO x1)
  3. Rifampin ( 600 mg PO q12 X2d)
64
Q

If exposed to pneumococcal meningitis, what can you give?

A

Nothing is recommended

65
Q

What is most common of meningitis and encephalitis?

A

Meningitis > Encephalitis

Aseptic > Bacterial

66
Q

Most common cause of sporadic fatal encephalitis in the US all year long:

A

HSV

67
Q

If a patient has HSV-2 they also may have:

A

Herpetic lesions on there genitals

68
Q

What lobe of the brain does HSV like to hit?

A

Temporal

69
Q

What are three later signs of an HSV encephalitis?

A
  • Word salad
  • Impaired memory
  • Loss of emotional control - Naked woman around the house
70
Q

What are the three findings in CSF for HSV encephalitis?

A
  1. Increased RBC - May be hemorrhagic
  2. Increased protein
  3. Lymphocytic pleocytosis
71
Q

Test for HSV by sending it for (when is it positive):

A

PCR - positive within 1st 24 hours of symptoms

72
Q

MRI findings for HSV +:

A

Unilateral temporal mass effect or changes

73
Q

Treatment of HSV encephalitis:

A

All ABX for bacterial meningitis + IV acyclovir (can stop the ABX when you are SURE it is not bacterial)

74
Q

Arbovirus encephalitis - Know ___

A

Flaviviridae - West NIle

75
Q

What tick is the Arbovirus encephalitis transmitter?

A

Deer dick

76
Q

1 cause of epidemic encephalitis in the US

A

West Nile virus - Flaviviridae

77
Q

Indicator of WNV in the US:

A

Dead birds (ravens and jays)

78
Q

Symptoms of WNV:

A

3-6 days (flu-like)

79
Q

What are the two serious things you can develop with WNV?

A
  • Polio-like paralysis (ascends - legs don’t work first)

- Mengioencephalitis or aseptic meningitis

80
Q

Testing for WNV:

A

Serum WNV for CSF (IgM) OR PCR - use the fourth tube

81
Q

Most common prion disease:

A

CJD

82
Q

Average age of CJD:

A

60 YO

83
Q

Most common cause of CJD (80%):

A

Sporadic

84
Q

What is Kuru?

A

Endocanabilism (W > M) can cause CJD

85
Q

Two categories of clinical findings in CJD:

A
  1. 100% cognitive (fast onset dementia)

2. 60% psychiatric (anxiety, euphoria etc.)

86
Q

Someone with CJD may have this when you scare them(80%):

A

Startle sensitive myoclonus

87
Q

Special test for CJD:

A

LP for CSF - RT-QulC assay/14-3-3-3 **CALL THE LAB - this can ruin equipment

88
Q

What two imaging studies will reveal abnormalities for CJD?

A

EEG and MRI

89
Q

Prognosis of CJD

A

Death within 1 year - no Tx.

Neuro. CM3 (11 decks)

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