Encephalitis/Meningitis Flashcards
Clinical presentation of encephalitis
- Altered mental status
- Seizures
- CN palsies
- Exaggerated DTR
Physical exam findings for encephalitis
- Papilledema***
- Rash
- Autonomic/Hypothalamic disturbances
- loss of temperature, vasomotor control, SIADH
- Arthritis
What would temporal lobe envolvement on MRI in encephalitis case indicate?
Herpes simplex virus
Cushings Triad
- Bradycardia
- Respiratory depression
- Hypertension
Should CSF be refrigerated?
No. kills fastidious organisms like N. meningitidis
Lumbar puncture with CSF that is clear, cloudy, or straw-colored with high protein content and high lymphocytes?
viral
When you are concerned for encephalitis who do you call?
Infectious disease and Neurology!!!! STAT
What are 5 situations it is important to get CT before LP in encephalitis
- GCS of <12
- New seizures
- Focal neuro signs
- Papilledema
- Immunocompromised
What are 3 things you need to do with an encephalitis patient?
- Stabilize (intubate, monitor…)
- Acyclovir
- Isolation
How do you treat someone with increased intracranial pressure
- Elevate head 30-45 degrees
- Hyperventilate
- Consider mannitol or corticosteroids
What is the #1 cause of viral meningitis?
Enterovirus (coxsackie, herpes (HSV-1))
What organism is most likely to cause bacterial meningitis in: Neonates (<1 month)
Group B streptococcus
What organism is most likely to cause bacterial meningitis in babies/children?
Streptococcus pneumoniae
What organism is most likely to cause bacterial meningitis in Adults 65+ and immunocompromised patients?
Listeria monocytogenes
When are pregnant women screened for group B strept?
35-37 weeks
What is the empiric antibiotic treatment for bacterial meningitis?
Ceftriaxone + Vancomycin
What is the empiric antibiotic treatment for bacterial meningitis in a patient over 50 (greater risk for listeria)
Ceftriaxone + Vancomycin + Ampicillin
What is the importance of corticosteroids when treating bacterial meningitis?
glucocorticoids (dexamethasone), reduce risk of hearing loss from antibiotics
Who should receive the quadrivalent meningitis vaccine (serotypes A, C, W, Y)?
~2months - 55 years
Who should receive meningococcal vaccine?
11-18 year olds, vaccinate at age 11-12.
Booster at age 16.
(if initial dose was given at age 16 no need for booster)
