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Foundations-Neuro > Encephalitis/Meningitis > Flashcards

Encephalitis/Meningitis Flashcards

1
Q

What are the 3 causes of CNS infections?

A
  1. Invasion of bloodstream
  2. Retrograde neuronal pathway-Olfactory or peripheral nerves
  3. Direct contiguous spread
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2
Q

Encephalitis presentation

A
  1. AMS
  2. Motor and or sensory deficits (abnormal cerebral function)-Focal neuro sx’s, CN deficits
  3. Seizures
  4. Altered behavior and/or personality change
  5. Profound lethargy
  6. Fever
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3
Q

What is the number one cause of encephalitis?

A

Viral: HSV-1 (MC)

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4
Q

Who is @ high risk for encephalitis?

A
  1. Outdoors
  2. Tavel to endemic areas
  3. Immunocompromised
  4. Lack of vaccines
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5
Q

List the viral causes of encephalitis

A
  1. Herpesvirus
  2. West Nile Virus- Arthorpod-borne viruses
  3. Rhabdovirus
  4. HIV
  5. Coxsackie-enteroviruses
  6. Measles
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6
Q

List bacterial causes for encephalitis

A
  1. Borrelia Burgdorferi (lyme dz)
  2. M. tuberculosis (TB)
  3. T.pallidum (Syphillis)
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7
Q

What organism would you suspect with flaccid paralysis PE findings?

A

West Nile Virus

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8
Q

List autonomic and hypothalamic disturbances you may find on physical exam findings in encephalitis

A
  1. Loss of temp and vasomotor control
  2. Diabetes insipidus
  3. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
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9
Q

What is the preferred imaging for encephalitis? What area of the brain is MC involved?

A

MRI

Temporal lobe-HSV

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10
Q

Encephalitis CSF findings

A
  1. Lymphocytosis
  2. Normal glucose
  3. Increased protein
  4. Straw colored
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11
Q

When is an LP contraindicated?

A
  1. Sign/Sx’s of Increased ICP: Decreased LOC, Focal neurologic sx’s, Papilledema
  2. Severe coagulopathy or on anticoagulant therapy
  3. Skin infection or spinal abscess @ LP site
  4. Mass lesion
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12
Q

Cushings triad

A

Sigs of increased ICP:

  1. Respiratory depression
  2. Bradycardia
  3. Hypertension
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13
Q

Caused for Pink-Red CSF

A
  1. Traumatic LP
  2. Subarachnoid hemorrhage
  3. Intracerebral hemorrhage
  4. Cerebral infarct
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14
Q

What does leukopenia and thrombocytopenia on a CBC indicate?

A

Ricketssial

Viral fevers

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15
Q

What does eosinophilia on a CBC indicate?

A

Drug induced encephalitis

Parasites

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16
Q

What does hyponatremia indicate?

A

Rickettsial infection

SIADH

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17
Q

What is the gold standard for encephalitis diagnosis?

A

Brain biopsy

Not routinely performed

18
Q

What is the most important treatment intervention in encephalitis? Why?

A

Acyclovir early

Decreases morbidity and mortality due to HSV and VZV encephalitis

19
Q

Meningitis risk factors

A
  1. Extremes of age
  2. Exposure risk-Close proximity
  3. Birth hx/maternal infection
  4. Vaccine status
  5. Injection drug use
20
Q

What is the number one cause of viral meningitis?

A

Enteroviruses: Coxsackie, herpangina

21
Q

What strain of HSV do we see in viral meningitis?

A

HSV-2

22
Q

CSF findings in viral meningitis?

A
  1. Clear or cloudy
  2. Lymphocytosis
  3. Normal glucose
  4. Increase protein
23
Q

Pathogen in neonates in bacterial meningitis

A

Group B Streptococcus

24
Q

Pathogen in babies and children in bacterial meningitis

A

S. peneumoniae

25
Q

Pathogen in teens and young adults bacterial meningitis

A

N. meningitidis

Accompanying petechial/purpra rash

26
Q

Pathogen in adults in bacterial meningitis

A

S. peneumoniae

27
Q

bacterial meningitis presentation

A
  1. Fever/chills
  2. Meningeal sx: HA, nuchal rigidity, kernigs sign, brudzinski
  3. AMS (DO NOT have to have this)
  4. N/V
  5. Photophobia
28
Q

When would you want to get a CT scan before LP?

A

signs of increased ICP–>r/o mass effect

29
Q

What is the first treatment intervention you want to do in bacterial meningitis?

A

Start empiric abx!!!

30
Q

What is the definitive dx for bacterial meningitis?

A

LP

31
Q

CSF findings in bacterial meningitis

A
  1. Neutrophils
  2. Decrease glucose (<45)
  3. Increased protein
  4. Increased CSF pressure
  5. Yellow color
32
Q

What is empiric abx treatment in bacterial meningitis?

A

Ceftriaxone or Cefotaxine (3rd generation)
+ Vanco
+Ampicillin IF 50+

33
Q

What is empiric abx treatment if you have a severe beta-lactam allergy in bacterial meningitis?

A

Vancomycin

+ Fluroquinolone (Moxifloxacin)

34
Q

What is empiric abx treatment if you have a severe beta-lactam allergy in bacterial meningitis AND you are 50+?

A

TMP-SMX

35
Q

Who is Dexamethasone recommended for?

A

Suspected S. pneumoniae

Decreases risk of developing neurologic sequela that is highly associated with S.pneumo

36
Q

Who is post-exposure prophylaxis indicated for?

A
  1. Prolonge contact: >8 hrs while in close proximity, <3 ft

2. Direct exposure to patients oral secretions during 7 days prior to sx’s onset AND until 24 hrs after initiating abx

37
Q

What serogroups does the quadrivalent meningococcal conjugate vaccine protect against?

A

A, C, W & Y

38
Q

Who is Menactra approved for?

A

9 mos-55 yrs.

39
Q

Who is Menveo approved for?

A

2 mos-55 yrs.

40
Q

List the vaccines that cover against serogroup B

A
  1. Trumenb: 10-25 yrs, 2-dose and 3 dose series

2. Bexsero: 10-25 yrs, 2-dose

41
Q

Who is Trumenb and Bexsero indicated for?

A
  1. Persistent complement component deficiency
  2. Asplenia
  3. Microbiolgist routinely working with N.meningitidis
  4. @ high risk

Foundations-Neuro (5 decks)

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