DSA 29 CNS Infections (McIntosh) Flashcards
what is Kernig’s sign?
flex the hip 90o and try to straighten the leg. patient gets intense pain in the back of the hamstring
what is Brudzinski’s sign?
flex the neck and the patient flexes the leg or both legs
which HSV causes herpes encephalitis? which HSV causes garden variety aseptic meningitis?
HSV-1, HSV-2
under what conditions do you perform brain imaging prior to lumbar puncture?
if patient has ANY of the following
- ) altered mental status
- ) focal neurologic deficit
- ) trauma
- ) immunocompromised
- ) papilledema
what is the difference in a CBC between bacterial meningitis and viral meningitis?
CBC is usually normal with a virus or maybe a mild luekocytosis
what is the difference between the clinical presentation between viral meningitis and bacterial meningitis?
the patients generally appear much less ill with a viral meningitis; mental status is not as altered as it is in bacterial meningitis
identify: cranial nerve abnormalities + headache + nuchal rigidity + fever
bacterial meningitis and viral encephalitis/meningoencephalitis
ALL patients with suspected bacterial meningitis should have what done first diagnostically?
labs drawn which is show CBC; then draw culture and an LP if there are no contraindications; if there are contraindications you have to do a CT scan first
what is the treatment for bacterial meningitis?
dexamethasone (steroid) + antimicrobial therapy (antibiotics + acyclovir)
true or false: morbidity and mortality are high in patients with bacterial meningitis
true
what if a member of a family is diagnosed with bacterial meningitis?
close contacts should receive prophylaxis such as an oral single dose cephalosporin or rifampin
who should avoid rifampin?
pregnant females
what is the difference between viral encephalitis/meningoencephalitis vs. just meningitis?
there are profound mental changes and more frequent seizures and focal neurlogical symptoms
what imaging is preferred for viral encephalitis?
MRI
what virus is positive on an MRI?
herpes simplex encephalitis
what are the CSF findings in viral encephalitis?
increased red blood cells in a non-traumatic LP; other than that it is identical to viral meningitis
presents with a subacute or chronic headache
fungal meningitis or tuberculous meningitis
frequent history of immunocompromised status
fungal or TB
brain imaging for subacute meningitis (TB or Fungal)
normal
identify: most common presenting symptom is headache along with a frequent history of preceding sinus, dental, or ear infections, mastoiditis, pulmonary infections or recent dental or neurological procedures
brain abscess
is fever present in a brain abscess?
present <50% of the time
What is the best diagnostic test?
brain MRI scan
What is the treatment for a brain abscess?
antibiotic therapy, surgical aspiration and drainage, anti-seizure medication
What is the etiology of a spinal cord abscess?
most of the time it is due to an infection from a brain abscess with hematogenous psread to the spinal cord epidural area
identify: spine pain is common presentation
spinal cord abscess
polyradicular findings of a spinal cord abscess occurs where in relation to the spinal cord?
occurs below the spinal cord
myelopathic findings if lesion encroaches where in a spinal cord abscess?
on the spinal cord directly
what is Cushion’s triad? what does it indicate?
hypertension + bradycardia + respiratory irregularity. indicates increased ICP
define fever in adults 18-40.
temp <98.9 in the AM or >99.9 in the PM
what is required for diagnosis of bacterial meningitis?
>2 of the following: fever, neck stiffness, headache, altered mental status
identify: this test is mandatory for the diagnosis of bacterial meningitis.
lumbar puncture
list general signs of increased ICP.
headache: occipitonuchal, holocephalic, worse supine, at night
N/V, lethargy/coma, papilledema, lateral rectus palsy, blurred vision, Cushing’s triad
how can you differentiate between meningitis and encephalitis based on clinical presentation?
both have headache and fever. meningitis will have meningismus. encephalitis will have mental status change, seizures, or focal signs.
what is the common pattern of meningial involvement in bacterial meningitis?
outer surfaces of cerebral hemispheres (cerebral convexities)
what part of the brain does tuberculosis like to infect?
the base of the brain
