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CABS - Neuro > CNS infections (cabs and clin med) > Flashcards

CNS infections (cabs and clin med) Flashcards

1
Q

what is the leptomeninges

A

the pia and arachnoid mater together

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2
Q

What is the dense outer layer

A

dura mater

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3
Q

what is the middle - web like layer

A

arachnoid mater
lies over the subarachnoid space which houses CSF

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4
Q

what is the Falx cerebri

A

folds into the longitudinal cerrebral fissue seperating the hemistpheres

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5
Q

what is the inner layer that is adhered to the brain parenchyma

A

pia matter
supports vasculature and creates the choroid plexus

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6
Q

Where is CSF made

A

within the choroid plexus of the ventricles in the pia matter

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7
Q

what is an inflammatory disease affecting the leptomeninges

A

Bacterial meningitis
MEDICAL EMERGENCY - DO NOT MISS

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8
Q

what prevents free flow of ions, cells and molecules from getting into the NS

A

BBB

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9
Q

what is the flow of CSF

A

secreted by choroid plexus within lateral ventricles
flows to third ventricle -> fourth ventricles -> flows outside of the brainstem into subarachnoid space (btwn pia and arachnoid), exits via arachnoid villi within the superior sagital sinus

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10
Q

What is rapidly fatal with mortality rate of 20-25% even with appropriate treatment

A

bacterial meningitis

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11
Q

what condition is fatal 70-100% of the time without treatment

A

bacterial meningitis

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12
Q

what are the predisposing factors of bacterial meningitis

A

prior viral infection
household crowding (college kids)
active and passive smoking
occupation risk (use and microbioligists)

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13
Q

what are the most common bacteria causing bacterial meningitis

A

S. pneumoniae
N. meningitidis
L. monocytogenese

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14
Q

what population is group B strep the cause of bacterial meningitis

A

Newborns

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15
Q

how can bacterial meningitis be spread

A

via droplet or secretions from colonized persons
bacterial entry into blood stream and enter CNS through BBB

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16
Q

where does bacteria cross the blood brain barrier

A

choroid plexus

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17
Q

what occurs when there is an inflammatory response with bacteria crossing the BBB

A

vasculitis and cerebral edema and increased ICP

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18
Q

what type of bacteria is Neisseria meningitidis

A

aerobic and gram negative diplococcus
outer membrane covered in polysaccharide which helps to resist phagocytosis

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19
Q

What is important about blood cultures

A

need to be extremely sterile and from two bodily sites

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20
Q

what is the drug of choice for N. meningitides

A

ceftriaxone

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21
Q

what type of bacteria is Streptococcus pneumoniae

A

lancet-shaped, gram positive, facultative anaerobic bacteria. typically diplococci.

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22
Q

what is the drug of choice against S. pneumoniae

A

Vancomycin plus ceftriaxone

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23
Q

what type of bacteria is listeria monocytogenes

A

gram positive facultative anaerobic bacilli

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24
Q

what are the likely presentation of listeria monocytogenesis in bacterial meningitis

A

seizures, focal deficits early in disease and ataxia

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25
Q

what is the drug of choice for listeria monocytogenes

A

ampicillin or penicillin (if allergic, Bactrim)

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26
Q

what type of bacteria is Haemorphilus influenzae

A

pleomorphic gram negative rods

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27
Q

where is haemorphilus influenze located

A

respiratory tract

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28
Q

what population is usually affected by haemorphilus influenzae

A

affects children most commonly

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29
Q

what is the drug of choice for Haemophilus influenzae

A

ceftriaxone

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30
Q

what is neucal regidity

A

neck stiffness

31
Q

what is the presentation of bacterial meningitis

A

typically present < 24 hours after onset of symptoms
classic triad: fever, stiff neck, AMS
fever
severe headache
N/V
possible seizure, coma, CN palsy
petechiae and palable purpura

32
Q

what are specific baby presentations of bacterial meninititis

A

poor feeding
irritable particularly when handles
high pitched or moaning cry
abnormal tone
vacant staring
poorly responsive or lethargic
tense fontanelle
cyanosis

33
Q

what is the difference between sepsis and meninigitis

A

sepsis = death from cardiovascular failure
meningitis = death from raised ICP

34
Q

what test has spontaneous flexion of hips with passive flexion or neck

A

Brudzinski sign

35
Q

what test is when there is an inability for full extension of the knee with hip flexion

A

Kernig

36
Q

what is the workup for bacterial meningitis

A

CBC
Coagulation studies
CMP
2 sets of blood cultures
head CT
LP
MRI

37
Q

what is a left shift of leukocytosis

A

immature WBCs

38
Q

what is seen on CBC for bacterial meningitis

A

leukocytosis with left shift and may have. thrombocytopenia

39
Q

what is the lumbar cistern

A

the pool of CSF in the lumbar spine

40
Q

when are LP contraindicated

A

anti-coagulated patients
if concern for herniation - elevated ICP (mass?)
if platelets < 50,000

41
Q

what is normal glucose levels on LP

A

45-85

42
Q

what is a LP for bacterial meninigitis positive for

A

> 200 mm H20 opening pressure
1,000 WBCs
Neutrophils present
200 protein
<40 glucose
positive gram stain and culture

43
Q

what is a LP for viral meningitis positive for

A

normal or slightly high opening pressure
100-1,000 WBCs
lymphocytes present
protein normal
normal glucose
negative gran stain and culture

44
Q

what is the plan for patient with concern for meningitis

A

ABC
VS hx, exam
2 large bore IV
LABS: CBC, CMP, PT/PTT, culture, lactate
fluids
treat shock
dexamethasone
antibiotics
antivirals
head CT
LP
exposure prophylaxis

45
Q

what is the treatment of bacterial meningitis

A

dexamethasone (prior to ABX)
Broad spectrum ABX
REAASSESS FREQUENTLY

46
Q

what is the classic antibiotic regimen for bacterial meningitis

A

cetriaxone, vancoymcin, ampicillin

if penicillin allergy: vancomycin and Bactrim

47
Q

what is used for prevention in people in close contact to known meningitis person

A

Chemoprophylaxis- ceftriaxone, rifampin or ciprofloxacin

48
Q

what is aseptic meningitis

A

negative bacterial cultures - but otherwise suggestive of bacterial meningitis
usually associated with enteroviruses

49
Q

what is the epidemoplogy of viral meningitis

A

infants <1yo or >5yo
most commonly in summer and fall

50
Q

what is the pathophysioloyg of viral meningitis

A

virus invades respiratory or GI track
typically 3-6 days after exposure
Enterovirus - peak in summer and fall
Herpes virus - HSV-1

51
Q

what is the presentation of viral meningitis

A

febrile
no neurologic dysfunction
headache
stiff neck
maculopapular rash
muscle aches
N/V
pharyngitis
fatigue

52
Q

what is the workup of viral meningitis

A

same as bacterial
negative gram stain and cultures for CSF
CSF shows lymphocytes
Send out CSF for viral detection assay
imaging: may see enhancement of the meninges on MRI

53
Q

what is the treatment of viral meningitis

A

typically supportive
depends on virus: acylovir IV
dark and quiet room
Tylenol for HA, fever, pain

54
Q

what is the difference between meningitis and encephalitis

A

mental status with menigitis is baseline but lethargic or distracted
mental status with encephalitis will be altered
ALWAYS ASSUME THE WROSE - IF QUESTION - START ABX

55
Q

what is encephalitis

A

inflammation of the brain parenchyma

56
Q

what are the common causes of encephalitis

A

unknown in half of the cases
20-50% viral etiology: HSV or VZV)
Genetic predisposition

57
Q

what is damaged with encephalitis

A

damage neurons can produce hemorrhagic necrosis

58
Q

what is the pathophysiology of encephalitis

A

viral
other infectious source
drug induced
autoimmune

59
Q

what are the 6 V’s of encephalitis

A

Vacation
Vaccination
Vectors
Viruses
Veterinary source
Vital statistics (people around you that have it)

60
Q

what is the presentation of encephalitis

A

AMS
fever
HA
N/V
Seizures
focal neurologic abnormalities
meningeal irritation if meningoencephalitis
disease specific findings

61
Q

what is the diagnostic criteria of encephalitis

A

Major: AMS lasting longer than or equal to 24 hours

Minor (2+): documented fever wtihin 72 hours
seizure
new onset focal neuro findings
CSF pleocytosis
abnormality of parenchyma on imaging
EEG abnormality consistent with encephalitis

62
Q

what is the workup of encephlitis

A

LP with same testing as before plus PCR and RT- PCR
include HSV1,2, VZV, enteroviruses, parechoviruses
can consider influenca, mumps, rabies
fresh water ameba
Imaging: MRI or CT

63
Q

what is a fresh water ameba that can cause encephalitis

A

naegleria fowleri

64
Q

what is the treatment of encephalitis

A

ABCs
Acyclovir for HSV and VZV encephalitis

65
Q

what is a focal collection of infection in the brain parenchyma

A

brain abscess

66
Q

who are brain abscesses more common in?

A

men

67
Q

what is the cause of brain abscess

A

direct spread from infection - otitis media, mastoiditis, dental infection
foreign body
post op infection

68
Q

what is the typical presentation of Brain abscess

A

headache
fever
neck stiffness
focal neurologic deficit
seizures
and CN VI palsy secondary to elevated ICP

69
Q

what is the presentation triad of brain abscess

A

headache, fever and focal neurologic deficit

70
Q

what type of imaging is necessary with concern for brain abscess

A

MRI WITH CONTRAST

71
Q

what is the initial treatment of brain abscesses

A

broad IV coverage abx (vanco, metronidazole, ceftriaxone) for 4-8 weeks with repeat imaging to guide and ensure clearance

72
Q

what is used if mass effect in brain abscesses is noted

A

steroids

73
Q

where is the most common sites of brain abscesses

A

frontal or temporal lobes

74
Q

when is excision considered for brain abscesses

A

if secondary to TBI and material in the abscess
fungal abscess
loculated
no improvement >1week of treatment
elevated ICP
increased size
AMS after initial drainage and treatment

CABS - Neuro (15 decks)

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