CNS Infections in Adults

Question 1

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

Answer 1

true

Question 2

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

Answer 2

false, mri/ct before lp

Question 3

t/f altered mental status points to encephalitis

Answer 3

false, meningoencephalitis

Question 4

cardinal features of acute bacterial meningitis

Answer 4

decreased consciousness
seizures
raised icp
stroke

Question 5

common organisms in acute bacterial meningitis

Answer 5

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

Question 6

clinical presentation of acute bac men

Answer 6

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

Question 7

dx of acute bac men

Answer 7

csf exam!
gold standard: csf culture

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

Question 8

csf abnormalities in bacterial meningitis

Answer 8

high opening pressure
low glucose
high protein

Question 9

tx of acute bac men

Answer 9

table 3

Question 10

adjunct treatments to acute bac men

Answer 10

dexamethasone – pneumococcal meningitis

Question 11

highest risk organism for mortality in acute bac men

Answer 11

s. pneumoniae

Question 12

indicators of poor prognosis for acute bac men

Answer 12

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

Question 13

etiologic agents of acute viral meningitis

Answer 13

enteroviruses*
hsv2
varicella zoster
ebv
arthropod borne viruses

Question 14

csf abnormalities in acute viral men

Answer 14

table 6, page 4

Question 15

tx for acute viral meningitis

Answer 15

supportive and symptomatic, no need for admission

antivirals: acyclovir, famciclovir, valacyclovir

Question 16

clinical presentation of viral encephalitis

Answer 16

altered or depressed consciousness (mild lethargy to severe coma)

Question 17

diffuse symptoms in viral encephalitis

Answer 17

HAPPy BEHrthday SEIyo

Question 18

focal symptoms in viral encephalitis

Answer 18

AA WITChDi SIAdh

Question 19

etiologic agents of viral encephalitis

Answer 19

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

Question 20

csf findings in viral encephalitis

Answer 20

table 9, page 5

Question 21

tx of viral encephalitis

Answer 21

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

Question 22

clinical manifestations of subacute meningitis

Answer 22

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

Question 23

causative organisms for subacute meningitis

Answer 23

tb meningitis
fungal (cryptococcal) meningitis
syphilitic meningitis

Question 24

characteristics of tb meningitis

Answer 24

inflammatory rxn with exudates in basilar cisterns and base of brain

abf culture is gold standard, csf pcr for faster results

Question 25

csf findings in tb meningitis

Answer 25

table 10, page 5

Question 26

tx for tb meningitis

Answer 26

HRZE for 12 mos | monitor for hydrocephalus

Question 27

organism found in cryptococcal meningitis

Answer 27

c. neoformans

Question 28

lab findings in cryptococcal men

Answer 28

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

Question 29

tx for cryptococcal men

Answer 29

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

Question 30

causative agent in syphilitic meningitis

Answer 30

t. pallidum, usually affects cn 7 and 8

Question 31

lab findings in syphilitic meningitis

Answer 31

reactive serum treponemal test (+) csf vdrl treponemal + nontreponemal tests

Question 32

tx for syphilitic meningitis

Answer 32

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

Question 33

cardinal features of chronic meningitis

Answer 33

``` >4 wks persistent headache stiff neck hydrocephalus cranial neuropathies radiculopathies cognitive or personality changes ```

Question 34

common bacterial cause of chronic meningitis

Answer 34

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

Question 35

cerebritis vs brain abscess

Answer 35

cerebritis: focal presentation, no capsule | brain abscess: has vascularized capsule

Question 36

common etiologies of brain abscess

Answer 36

``` streptococcus sp. (sinusitis) enertobacteriaceae (nosocomial) anaerobes (dental) staphy tuberculoma ```

Question 37

clinical manifestations of brian abscess

Answer 37

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

Question 38

dx for brain abscess

Answer 38

mri* (can see ring enhancement) | stereotactic needle aspiration

Question 39

tx for brain abscess

Answer 39

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