CNS infections - Pino Flashcards
most common cause of fever is associated with signs and symptoms of what disease
CNS disease
what is the most common agent to cause CNS disease
viral
nuchal rigidity
inability to flex neck forward
obtundation
less than full alertness
stupor
a state of near-unconsciousness or insensibility
what brain structure are involved for meningitis
meninges
what brain structure is involved for encephalitis
parenchyma
what is Meningoenceohpalitis
both meningitis and encephalitis
DIAGNOSIS OF DIFFUSE CNS INFECTIONS DEPENDS ON WHAT
EXAMINATION OF CNS
LUMBAR PUNCTURE
what are 3 bacteria that cause neonate bacterial meningitis
group B step
E. coli
Listeria
what are 3 bacteria that cause 2mos - 12 yr bacterial meningitis
strep pneumo
Neisseria meningitidis
H. flu b
what are 3 bacteria that cause immunosuppressed bacterial meningitis
pseudomonas
staph
salmonella
listeria
what happens to the brain in bacterial meningitis
meningeal purulent exudate
ventriculitis
cerebral infarction
increased intracranial pressure
what is the CSF fluid for bacterial meningitis
increased protein
decreased glucose
increase white count ( neutrophils)
how can bacteria enter CNS
bacteremia
choroid plexus
what are sudden clinical manifestations for bacterial menigitis
shock
purpura
what are insidious clinical manifestations for bacterial menigitis
fever
URI, GI
irritability
what are PE tests that can be done
Nuchal rigidity
back pain
Kernig
Brudzinski
Nuchal rigidity
inability to flex the neck forward
Kernig
Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.
Brudzinski
Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.
when a child has open fontelle, what PE will not work, which ones will
not work: Kernig and Brudzinski
work: Nuchal ridgitiy
what do neonates have in their spinal tap that is not present in normal adults
elevated white count
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
NO
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
