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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 ā€¦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 ā€”then start IV acyclovir if radiological c/is to LP ā€¦if not do LP!
  3. if pt is immunocomprom. 0or 3 mos.-12 y.o ā€”-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
Q

How does Tuberculous meningitis come about?

A
  • by reactivation of TB (esp. in immunocompromised; elderly) ; previous TB CXR
26
Q

How to treat TB meningitis?

A

Isoniazid+Rifampicin

27
Q

When to suspect fungal meningitis?

A
  • in HIV patient (those with CD4<100)
  • aseptic picture on CSF
  • subtle neurological fts
28
Q

How to diagnose Fungal Meningitis?

A
  • those with serum and csf cryptococcal antigen
29
Q

Rx of Fungal Meningitis?

A

IV amphotericin B and Fluconazole

30
Q

What bloods should be taken for suspected Meningitis or Meningococcal sepsis?

A
  • blood cultures, FBC, U&E, Electrolytes, LFTs, Clotting screen, CRP (or procalcitonin)
  • meningoccal and pneumococcal PCR, serology sample and GLUCOSE
31
Q

What alternative is given if the patient if allergic to Penicillins (beta lactams) or cephalosporins?

A

Chloramphenicol (25mg/kg QDS, IV) & Dexamethasone 10 mg, qds, IV

32
Q

What cells are predominantly present in VIRAL and TB Meningitic?

A

lymphocytes

33
Q

What are DDX for neutrophilic pleocytosis and low csf glucose? (not bact. meningitis) (5)

A
  • 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
Q

What are non-infectious causes of ASEPTIC meningitis?

A
  • carcinomatous
  • sarcoidosis
  • vasculitis
  • dural venous sinus THROMBOSIS ā€˜
  • migraine
  • drug (co-trimazole, IVIG, NSAIDS)
35
Q

What are the indications for hospital admission in suspected Bacterial meningitis?

A
  • impaired consciousness +meningeal irritation signs
  • petechial rash
  • febrile pts or had a recent fit
  • close contacts with headache
36
Q

What should be done on arrival of suspected meningitis pt?

A
  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
Q

How to manage raised ICP?

A
  • high flow O2
  • IV ceftriaxone
    -volume resuscitation
    -30 degr. HEAD ELEVATION
    -ICU management
    intubation+ventilation
38
Q

When are steroids c/i?

A
  • post-surgical meningitis
  • immunocompromised
  • septic shock
  • allergic to steroids
39
Q

Who to contact for prevention of Secondary Cases of Meningitis ?

A

Public health or Health Protection

40
Q

What is given as prophylaxis for school or community outbreaks of meningitis?

A

500mg Ciprofloxacin oral, single dose

41
Q

What are the s/eā€™s of Rifampicin?

A

reduced efficacy of OCP, red urine, stained contact lens

42
Q

What vaccines are available?

A
  1. N.Meningitidis (serogroup A and C)
  2. HiB vaccine
  3. Pneumococcal vaccines (polysaccharide & conjugate)
43
Q

What occurs in the Uncal Herniation?

A
  • lager supratentorial mass, pushes the IPSILATERAL inferomedial temporal lobe through the temporal incisura and the midbrain.
44
Q

What is compressed in an Uncal Herniation? (3)

A
  • 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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