CNS Infections

Question 1

What are the common clinical presenting S/Sx with bacterial meningitis

Answer 1

Fever
Nuchal rigidity
Change in mental status
HA
N, V, Photophobia

Question 2

Infants may present slightly differently than adults; what other S/Sx might infants present with?

Answer 2

Paradoxic irritability (quiet stationary, crying when held)
Vomiting, poor feeding
Hypotonia
Bulging fontanelle (only if euvolemic)

Question 3

T/F

Viral meningitis is typically a self-limiting condition.

Answer 3

True

Usually last 7 to 10 days. Only way to distinguish b/t bacterial and viral however is an LP

Question 4

What is the most common cause of Acute Viral Meningitis?

Answer 4

Enteroviruses

Question 5

What are the 3 most common microorganisms which cause bacterial meningitis in ADULTS?

What about infants?

Answer 5

N. meningitidis
S. pneumoniae
Listeria monocytogenes

Group B strep
Listeria monocytogenes
E. coli

Question 6

How do you determine the difference between viral and bacterial meningitis; what would you order?

Answer 6

Lumbar Puncture
Blood cultures
CSF
    ~WBC, RBC, glucose, protein, gram stain, w/ CULTURE 
PCR (viral testing)

Question 7

When would a lumbar puncture be contraindicated?

Answer 7

ICP

Question 8

What are some potential complications of a Lumbar Puncture which you should educate your PT about before performing this procedure?

Answer 8

Post-LP HA  (have lie down for 2-3hrs, no heavy lifting 2-3 days, can take tylenol, etc)
Infection (meningitis)
Bleeding
Cerebral herniation
Epidermoid tumors of thecal sac
Back Px / Radicular Px

Definitive Tx for Post LP HA is a blood patch

Question 9

When would an EEG be indicated?

Answer 9

To evaluate possible seizure activity
(Epilepsy and the region of the brain involved)
Brain tumor
Stroke
Encephalitis