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08 Neuro > CNS Infections in Adults > Flashcards

CNS Infections in Adults Flashcards

1
Q

t/f empirical therapy should be initiated promptly if bacterial meningitis is a possibility

A

true

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2
Q

t/f you can do a lumbar tap before ct scan in all patients

A

false, mri/ct before lp

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3
Q

t/f altered mental status points to encephalitis

A

false, meningoencephalitis

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4
Q

cardinal features of acute bacterial meningitis

A

decreased consciousness
seizures
raised icp
stroke

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5
Q

common organisms in acute bacterial meningitis

A

s. penumoniae*
n. meningitides (younger age groups, petechiae/pupura, death)
group b streptococci (neonates, >50 yo)
enteric g(-) bacilli (post surgical)
s. aureus (post-op)
listeria monocytogenes
h. influenzae

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6
Q

clinical presentation of acute bac men

A

acute fulminant illness or subacute infection that progressively worsens
triad: fever, headache, nuchal rigidity

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7
Q

dx of acute bac men

A

csf exam!
gold standard: csf culture

blood culture, csf analysis (pcr), ct/mri

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8
Q

csf abnormalities in bacterial meningitis

A

high opening pressure
low glucose
high protein

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9
Q

tx of acute bac men

A

table 3

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10
Q

adjunct treatments to acute bac men

A

dexamethasone – pneumococcal meningitis

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11
Q

highest risk organism for mortality in acute bac men

A

s. pneumoniae

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12
Q

indicators of poor prognosis for acute bac men

A

decreased consciousness
seizures within 24 hrs onset
increased icp
>50 yo
comorbidities, shock, mechanical ventilation
delayed treatment
csf protein > 300 mg/dl, glucose <40 mg/dl

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13
Q

etiologic agents of acute viral meningitis

A 
enteroviruses*
hsv2
varicella zoster
ebv
arthropod borne viruses
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14
Q

csf abnormalities in acute viral men

A

table 6, page 4

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15
Q

tx for acute viral meningitis

A

supportive and symptomatic, no need for admission

antivirals: acyclovir, famciclovir, valacyclovir

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16
Q

clinical presentation of viral encephalitis

A

altered or depressed consciousness (mild lethargy to severe coma)

17
Q

diffuse symptoms in viral encephalitis

A

HAPPy BEHrthday SEIyo

18
Q

focal symptoms in viral encephalitis

A

AA WITChDi SIAdh

19
Q

etiologic agents of viral encephalitis

A

herpesviruses (cmv, hsv 1/2, hhv 6, vzv, ebv)
arthropod borne virus
enterovirus

20
Q

csf findings in viral encephalitis

A

table 9, page 5

21
Q

tx of viral encephalitis

A

supportive, monitoring in ICU, ventilator, anticonvulsants, antivirals (iv acyclovir)

22
Q

clinical manifestations of subacute meningitis

A

unrelenting headache, stiff neck, low grade fever, lethargy (days to weeks)

23
Q

causative organisms for subacute meningitis

A

tb meningitis
fungal (cryptococcal) meningitis
syphilitic meningitis

24
Q

characteristics of tb meningitis

A

inflammatory rxn with exudates in basilar cisterns and base of brain

abf culture is gold standard, csf pcr for faster results

25
Q

csf findings in tb meningitis

A

table 10, page 5

26
Q

tx for tb meningitis

A

HRZE for 12 mos

monitor for hydrocephalus

27
Q

organism found in cryptococcal meningitis

A

c. neoformans

28
Q

lab findings in cryptococcal men

A

csf lymphocytic pleocytosis with inc protein, low glucose
(+) india ink
polysaccharide antigen or latex agglutination

29
Q

tx for cryptococcal men

A

amphotericin b iv + flucytosine x 2 wks followed by 8-10 wks of oral fluconazole

30
Q

causative agent in syphilitic meningitis

A

t. pallidum, usually affects cn 7 and 8

31
Q

lab findings in syphilitic meningitis

A

reactive serum treponemal test
(+) csf vdrl

treponemal + nontreponemal tests

32
Q

tx for syphilitic meningitis

A

iv or im aqueous penicillin g x 2 wks followed by im benzathine penicillin weekly x 3 wks

33
Q

cardinal features of chronic meningitis

A 
>4 wks
persistent headache
stiff neck
hydrocephalus
cranial neuropathies
radiculopathies
cognitive or personality changes
34
Q

common bacterial cause of chronic meningitis

A

partially treated suppurative meningitis, parameningeal infection, m. tuberculosis, syphilis

35
Q

cerebritis vs brain abscess

A

cerebritis: focal presentation, no capsule

brain abscess: has vascularized capsule

36
Q

common etiologies of brain abscess

A 
streptococcus sp. (sinusitis)
enertobacteriaceae (nosocomial)
anaerobes (dental)
staphy
tuberculoma
37
Q

clinical manifestations of brian abscess

A

expanding cranial mass, depend on location and level of icp
meningismus often absent
classic triad: headache, fever, focal neurologic deficit

38
Q

dx for brain abscess

A

mri* (can see ring enhancement)

stereotactic needle aspiration

39
Q

tx for brain abscess

A

immunocompetent: cefotaxime or ceftriaxone + metronidazole (for poly)
penetrating head trauma: ceftazidime + vanco OR meropenem + vanco

08 Neuro (24 decks)

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