CNS infections - Pino Flashcards by Bina Malapur

most common cause of fever is associated with signs and symptoms of what disease

CNS disease

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what is the most common agent to cause CNS disease

viral

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nuchal rigidity

inability to flex neck forward

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obtundation

less than full alertness

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stupor

a state of near-unconsciousness or insensibility

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what brain structure are involved for meningitis

meninges

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what brain structure is involved for encephalitis

parenchyma

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what is Meningoenceohpalitis

both meningitis and encephalitis

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DIAGNOSIS OF DIFFUSE CNS INFECTIONS DEPENDS ON WHAT

EXAMINATION OF CNS

LUMBAR PUNCTURE

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what are 3 bacteria that cause neonate bacterial meningitis

group B step
E. coli
Listeria

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what are 3 bacteria that cause 2mos - 12 yr bacterial meningitis

strep pneumo
Neisseria meningitidis
H. flu b

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what are 3 bacteria that cause immunosuppressed bacterial meningitis

pseudomonas
staph
salmonella
listeria

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what happens to the brain in bacterial meningitis

meningeal purulent exudate
ventriculitis
cerebral infarction
increased intracranial pressure

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what is the CSF fluid for bacterial meningitis

increased protein
decreased glucose
increase white count ( neutrophils)

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how can bacteria enter CNS

bacteremia

choroid plexus

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what are sudden clinical manifestations for bacterial menigitis

shock

purpura

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what are insidious clinical manifestations for bacterial menigitis

fever
URI, GI
irritability

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what are PE tests that can be done

Nuchal rigidity
back pain
Kernig
Brudzinski

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Nuchal rigidity

inability to flex the neck forward

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Kernig

Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.

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Brudzinski

Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.

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when a child has open fontelle, what PE will not work, which ones will

not work: Kernig and Brudzinski

work: Nuchal ridgitiy

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what do neonates have in their spinal tap that is not present in normal adults

elevated white count

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when should someone not do a spinal tap? how do you determine if they have this condition?

evidence of increased intracranial pressure
- 3rd or 6th cranial nerve palsy 
- Cushing's triad
cardiorespiratory compromise
skin infection of LP site

Cushing's triad

hypertension bradycardia irregular respiratory

can you do a spinal tap on a child with bulging fontanel

yes

how do you treat a neonate bacterial meningitis

Ampicillin + aminoglycoside | ampicillin + 3rd generation cephalosporin ( Cefotaxime)

treatment for strep pneumo menintigits

vancomycin + 3rd generation cephalosporin

treament for Neisseria menintigits

cefotaxime/ceftriaxone

treatment for H. flu B

cefotaxime/ceftriaxone

treatment for immunocompromised

ceftazidime + aminoglycosides

SHOULD YOU DELAY THERAPY WHILE WAITING FOR AN LP

when should corticosteroids be used for treatment

H. flu B meningitis

what are some complications for treating bacterial meningitis

seizures increased ICP stroke

what type of bacterial meningitis has the highest mortality

pneumococcal meningitis

when is prognosis worse for patient for bacterial meningitis

less then 6 months | - high concentration bacteria in CSF

what is the most common sequela with bacterial meningitis

sensorinerual hearing loss

what are 2 methods to prevent bacterial meningitis

vaccination | anit-biotic prophylaxis

what bacteria do you give antibiotic prophylaxis for? and what antibiotic is given

Neisseria H. flu B rifampin

what defines close contact with Neisseria and H. flu B

Neisseria: close contact | H. flu b: 4H/day for 5/7 days

what is the most commone viral meningoencephalitis

enterovirus

What time of the year and from what can someone get arbovirus viral meningoencephalitis

summer mosquitoes, ticks vectors west nile

what are clinical symptoms of viral Meningoencephalitis

hallucinations | bizarre movements

how do you differentiate between bacterial and viral meningitis with spinal tap

viral: PCR bacterial: culture

what appears in spinal tap for viral Meningoencephalitis

mononuclears normal to slightly elevated proteins glucose normal

how do you test west nile virus

CSF serology

ANY FINDINGS SUGGESTIVE OF TEMPEROAL LOBE INVOLVMENT SHOUDL AROUSE WHAT SUSPICION

HSV

what is the treatment for viral Meningoencephalitis

supportive | Acyclovir

prognosis for viral Meningoencephalitis

most complete recovery

for viral Meningoencephalitis what follow ups should be done

eye and ear

what makes CSF fluid

choroid plexus | - lateral 3rd and 4th ventricles

what takes up CSF fluid

arachnoid vili | -superior sagittal sinus

why would someone get a spinal tap

CNS infection | deliver medications

when would you not give spinal tap

local skin infection increased ICP hemodynamic instability

what is the most common complication with spinal taps

headache

what position should the patient be sitting in for spinal taps

laying or sitting

what is the name of the needle

Regular Bevel

between what vertebrae can spinal tap occur

3rd and 4th vertebra

what space in the vertebra does the need go into

subarachnoid space