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Foundations II (Cholley) > Encephalitis, meningitis > Flashcards

Encephalitis, meningitis Flashcards

1
Q

How do pts w/ encephalitis present?

A
  • Fever
  • Altered mental status
  • Seizures
  • Focal neuro sx
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2
Q

What do you see on PE for encephalitis?

A
  • Papilledema
  • Rash
  • Autonomic & hypothalamic disturbances
  • Arthritis
  • Retinitis
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3
Q

What imaging do you use for dx of encephalitis?

A
  • MRI > CT
  • Start w/ CT w/out contrast if pt is SICK (faster, r/o mass lesion)
  • MRI: hyperintensity in areas of edema
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4
Q

What are contraindications to doing a lumbar puncture?

A
  • Si/sx of increased ICP
  • Severe coagulopathy
  • Skin infection
  • Mass lesion
  • If pt has any of the above, CT > LP
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5
Q

What makes up cushing’s triad?

A
  1. Respiratory depression
  2. Bradycardia
  3. HTN
    * Seen in encephalitis
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6
Q

What is cloudy CSF indicative of?

A

Bacterial meningitis

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7
Q

What are other causes of elevated WBCs in lumbar puncture sample?

A
  • Vasculitis
  • Leukemic infiltration
  • Traumatic tap*
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8
Q

What is the gold standard for dx of encephalitis?

A

Brain biopsy

- Invasive, not the initial test performed

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9
Q

How do you tx encephalitis?

A
  • Stabilize (ET tube, vent, circulatory support)
  • Antiviral therapy*
  • Tx offending agent
  • Prevent secondary bacterial infections, DVT, GI prophylaxis.
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10
Q

How can you tx increased ICP?

A
  • Elevate head to 30-45˚
  • Avoid compression to jugular veins
  • Hyperventilate
  • Corticosteroids & mannitol
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11
Q

What is empiric therapy for encephalitis? What is the % of survival?

A 
Start Acyclovir (early): decreases morbidity/ mortality
- Up to 90% survival
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12
Q

How do you prevent encephalitis?

A

Avoid vectors!

- Bug spray, barriers, avoid areas/times when mosquitos are active

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13
Q

What are classic sx of meningitis?

A
  • HA
  • Photophobia
  • N/V
  • Neck stiffness
  • Fever
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14
Q

What are complications of bacterial meningitis?

A

If not fatal, can cause:

  • neurological sequelae
  • brain damage
  • hearing loss
  • learning disabilities
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15
Q

What are characteristics of “viral” meningitis?

A
  • Aseptic
  • Often indistinguishable from bacterial meningitis based on presentation alone
  • Course usually self-limited
  • # 1 cause = entero
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16
Q

What is the typical CSF analysis for “viral” meningitis?

A
  • Colorless

- Can be cloudy

17
Q

What is the typical CSF for encephalitis?

A

Straw-colored

18
Q

How do neonates acquire “bacterial” meningitis?

A

From birth canal

19
Q

Suspected bacterial meningitis = ________

A

EMERGENCY

20
Q

What is the #1 pathogen causing “bacterial” meningitis in neonates?

A

Group B streptococcus

21
Q

1 cause of bacterial meningitis in babies/children?

A

strep pneumoniae

22
Q

1 cause of bacterial meningitis in teens & young adults?

A

Neisseria meningitidis

23
Q

1 cause of bacterial meningitis in adults?

A

streptococcus pneumoniae

24
Q

What organism do you need to test for in pregnant women? At how many weeks should you perform?

A

GBS

35-37 wks gestation

25
Q

How do you tx pregnant women who are positive for GBS?

A

prophylactic abx during labor

26
Q

How does “bacterial” meningitis present?

A

may be slow or rapid onset

Classic sxs: fever, meningismus, AMS, severe HA

+/- N/V, photophobia, back pain

27
Q

How does “bacterial” meningitis present in neonates?

A

classic sxs

+ irritability, poor feeding, lethargy, high-pitched cry, “floppy”, rash, +/- seizures

28
Q

How do you dx/manage “bacterial” meningitis?

A
  • IV access
  • Blood cx x 2 (diff sites, diff times)
  • Abx
  • CBC, CMP, coag
  • +/- CT
  • LP
29
Q

Can you delay abx?

A

NO!

if LP is delayed bc of CT scan, start abx after obtaining blood cultures

30
Q

What meds do you use to tx “bacterial” meningitis?

A

Ceftriaxone or cefotaxime
+ Vanco
+ Ampicillin (if over age 50)

31
Q

How do you tx pts w/ “bacterial” meningitis who are allergic to PCN?

A

Vanco + moxifloxacin

- If over 50yo, tx w/ TMP-SMX

32
Q

Who should you give chemoprophylaxis for “bacterial” meningitis?

A
  • Prolonged contact while in close proximity
  • Direct exposure to pt’s oral secretions during 7 days prior to sx onset & until 24 hrs after initiation of abx therapy
33
Q

What vaccines are available for meningitis?

A

Quadrivalent conjugate vaccines against A, C, W, & Y:

  • Menactra
  • Menveo

Vaccines against serogroup B:

  • Trumemba
  • Bexsero
34
Q

What “clues” indicate viral meningitis?

A
  • HSV w/ genital lesions (usually precede meningitis sx)

- Mumps

35
Q

Common organism responsible for bacterial meningitis in pts over 65 y/o or immunocompromised?

A

Listeria monocytogenes

36
Q

Which will always have AMS: bacterial meningitis or encephalitis?

A

ENCEPHALITIS

37
Q

What kind of rash is highly associated with neisseria meningitis?

A

petechia/purpura

Foundations II (Cholley) (25 decks)

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