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CNS Infections Flashcards

HARD AF

1
Q

Consequences of CNS Infections (4)

A
  • brain HERNIATION and death

- Cord compression and necrosis (subsequent permanent paralysis)

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2
Q

What is seen with Pyogenic Meningitis? (2)

A

thick layer of suppurative exudate covering the leptomeninges (over the surface of the brain)

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3
Q

What is seen microscopically in the subarachnoid space?

A

Neutrophils

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4
Q

What bacterial spp. is responsible for meningitis in pts >60y.o?

A

Listeria spp.

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5
Q

Name 3 bacterial spp. causing meningitis.

A

Step. Pneumococcus, Neisseria Meningitidis, H.Influenzae

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6
Q

How to approach a suspected Bacterial Meningitis ?

A

Immediately start the pt. on CEFTRIAXONE (IV 2g,BD) and DEXAMETHASONE (IV 10mg, qds)

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7
Q

When do you continue Dexamethasone administration in bacterial meningitis ?

A

only when the culture comes back positive for Strep. Pneumoniae (continue for 4 days) with 10 days of ceftriaxone …stop if anything else

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8
Q

What do you add on if culture comes back positive for Listeria?

A

Amoxicillin IV, 2mg/4hr for 21 DAYS

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9
Q

How does recent travel to (canada, paki, mexico, greece, china, italy, turkey, croatia, spain, usa, poland) ALTER antibiotic treatment? why?

A

administer IV VANCOMYCIN (15-20mg) as these countries have high rates of penicillin/cephalosporin resistant pneumococci for 14 days with ceftriaxone

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10
Q

What causes viral meningitis?

A

enteroviruses (ECHO virus)

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11
Q

How to diagnose Viral Meningitis?

A

-throat swab, stool culture, CSF PCR

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12
Q

Name 3 contraindications to LUMBAR PUNCTURE.

A
  • gcs <13 or falling >2
  • papilloedema + doll eyes
  • bradycardia and H/T

Others (neurological deficits, immunocompromised, systemic shock, meningococcal SEPTICEMIA, after seizures)

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13
Q

After performing ABCD and Glucose test for suspected viral encephalitis, what must be done?

A
  1. LP if possible (if +, start IV Acyclovir)
  2. If LP not possible, perform CT of brain —then start IV acyclovir if radiological c/is to LP …if not do LP!
  3. if pt is immunocomprom. 0or 3 mos.-12 y.o —-21 DAYS of acyclovir (normally 14 days)
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14
Q

Name 3 radiological C/Is to LP.

A
  • significant BRAIN shift or SWELLING
  • tight basal CISTERNS
  • alternate dx
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15
Q

List a few special qs to ask a patient with suspected viral encephalitis.

A
  1. Recent Vaccination?
  2. Animal and fresh water contact?
  3. HIV risk factors?
  4. Exposure to mosquito bites?
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16
Q

What are the symptoms of ENCEPHALITIS?

A
  • CONFUSION
  • STUPOR
  • Insidious onset (sometimes sudden)
  • SEIZURES & SPEECH and Memory symptoms
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17
Q

What IVX can be done for encephalitis?

A

LP, EEG, MRI

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18
Q

What are the cardinal signs of SEPTICEMIA ?

A

fever and red RASH that does not fade under pressure (non-blanching)

19
Q

If a pt has a hx of head trauma or neurosurgery, what is the most liekly cause of meningitis?

A

Staphylococcus AUREUS, AND EPIDERMIDIS

- aerobic GNR

20
Q

What bacteria is responsible for meningitis, if post-fracture of the cribiform plate?

A

Strep.Pneumonaie, H.Influenzae, Beta-hemolytic strep.

21
Q

What are complications of Meningitis?

A
  • Purulence in brain
  • Invasion to ventricles
  • cerebral edema
  • ventriculitis/hydrocephalus
22
Q

Why does hydrocephalus occur as a consequence of meningitis?

A

the purulent exudate accumulating at the 4th Ventricle openings and around the sulci, disrupt the CSF flow

23
Q

Which type of H.Influenza is found in kids under 4y.o with meningitis?

A

H.Influenza type B

24
Q

Who is most susceptible to Strep. Pneumonaie?

A

those with CNS devices (COCHLEAR implants) /diabetics/alcoholics/children/those with basillar skull fractures/ those hospitalized

25
How does Tuberculous meningitis come about?
- by reactivation of TB (esp. in immunocompromised; elderly) ; previous TB CXR
26
How to treat TB meningitis?
Isoniazid+Rifampicin
27
When to suspect fungal meningitis?
- in HIV patient (those with CD4<100) - aseptic picture on CSF - subtle neurological fts
28
How to diagnose Fungal Meningitis?
- those with serum and csf cryptococcal antigen
29
Rx of Fungal Meningitis?
IV amphotericin B and Fluconazole
30
What bloods should be taken for suspected Meningitis or Meningococcal sepsis?
- blood cultures, FBC, U&E, Electrolytes, LFTs, Clotting screen, CRP (or procalcitonin) - meningoccal and pneumococcal PCR, serology sample and GLUCOSE
31
What alternative is given if the patient if allergic to Penicillins (beta lactams) or cephalosporins?
Chloramphenicol (25mg/kg QDS, IV) & Dexamethasone 10 mg, qds, IV
32
What cells are predominantly present in VIRAL and TB Meningitic?
lymphocytes
33
What are DDX for neutrophilic pleocytosis and low csf glucose? (not bact. meningitis) (5)
- viral mening. (earlier phase) - leakage of brain ABSCESS into ventricle - amebic meningoencephalitis - TB meningitis - parameningeal foci/cerebritis chemical meningitis; BEHCET $, Drug induced (INH, NSAIDs)
34
What are non-infectious causes of ASEPTIC meningitis?
- carcinomatous - sarcoidosis - vasculitis - dural venous sinus THROMBOSIS ' - migraine - drug (co-trimazole, IVIG, NSAIDS)
35
What are the indications for hospital admission in suspected Bacterial meningitis?
- impaired consciousness +meningeal irritation signs - petechial rash - febrile pts or had a recent fit - close contacts with headache
36
What should be done on arrival of suspected meningitis pt?
1. ABCD 2. blood culture and coagulation screening 3. Start antibiotic rx (Ceftriax+dexamethasone) 4. throat swab 5. swab petechial rash 6. LP if not c/i
37
How to manage raised ICP?
- high flow O2 - IV ceftriaxone -volume resuscitation -30 degr. HEAD ELEVATION -ICU management intubation+ventilation
38
When are steroids c/i?
- post-surgical meningitis - immunocompromised - septic shock - allergic to steroids
39
Who to contact for prevention of Secondary Cases of Meningitis ?
Public health or Health Protection
40
What is given as prophylaxis for school or community outbreaks of meningitis?
500mg Ciprofloxacin oral, single dose
41
What are the s/e's of Rifampicin?
reduced efficacy of OCP, red urine, stained contact lens
42
What vaccines are available?
1. N.Meningitidis (serogroup A and C) 2. HiB vaccine 3. Pneumococcal vaccines (polysaccharide & conjugate)
43
What occurs in the Uncal Herniation?
- lager supratentorial mass, pushes the IPSILATERAL inferomedial temporal lobe through the temporal incisura and the midbrain.
44
What is compressed in an Uncal Herniation? (3)
- compression of the III CN (=dilated ipsilateral eye) - quickly followed by C/L HEMIPARESIS - COMA from pressure on ARAS in midbrain

NEUROLOGY (36 decks)

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