Falkenberg: CNS Infections

Question 1

How do most bugs get into the CNS?

Answer 1

hematogenous/venous spread
i.e. abcess, respiratory, GI/GU, pericranial sites like sinuses and middle ear

**less common: penetrating trauma

Question 2

What is meningitis vs encephalitis vs myelitis?

Answer 2

meningitis: infection of meninges
encephalitis: infection of brain
myelitis: infection of spinal cord

Question 3

CNS infections are emergencies, b/c the brain is enclosed. What can increased intracranial pressure lead to if left untreated?

Answer 3

herniation of brain and necrosis

Question 4

Infection of the CNS can also lead to (blank) throughout the body

Answer 4

sepsis

Question 5

What are these signs and symptoms of?

headache
nausea and vomiting
fever
meningismus
altered consciousness

Answer 5

acute bacterial meningitis

Question 6

What should you do for children who are less than 28d/0 w a fever greater than 100.6?

Answer 6

full septic work-up including lumbar puncture

Question 7

Should you do a lumbar puncture in an infant if you suspect bacterial meningitis?

Answer 7

yes!

Question 8

Causes of bacterial meningitis?

Answer 8

S. pneumoniae
H. influenzae
L. monocytogenes
Group B streptococcus
N. meningitidis

Question 9

How to diagnose meningitis?

Answer 9

H&P
CT of head to rule out space occupying lesion
lumbar puncture
blood cultures *can be systemic and spread to the blood

Question 10

What are some differences in CSF in bacterial vs viral infections?

Answer 10

bacterial: pressure >30, turbid appearance, protein >1g/L, PMN, gram stain positive
viral: normal to slightly increased pressure, clear appearance, <1g/L protein, monocytes

Question 11

Treatment for meningitis?

Answer 11

antibiotics *that cross the BBB
hospitalization
steroids *to help w inflammation
supportive care

Question 12

What are these symptoms of?

headache
fever
viral syndrome *feeling of malaise
meningismus

Answer 12

viral meningitis

**not as sick as pt w bacterial meningitis

Question 13

What are the causes of viral meningitis?

Answer 13

enteroviruses

Question 14

Treatment for viral meningitis?

Answer 14

Usu resolves in 7-10 days, so let it be. Can use some antivirals.

Question 15

What are these symptoms of?

*confusion
*personality change
altered mental status
fever
seizures

Answer 15

encephalitis

**these symptoms make sense, b/c the brain is involved, not just the meninges

Question 16

Causes of encephalitis?

Answer 16

herpes simplex virus
varicella zoster virus
HIV
Rabies virus
etc

**seen often in immunosuppresed disorders

Question 17

How to diagnose encephalitis?

Answer 17

H&P
Brain image to rule out space occupying lesion
lumbar puncture
culture of CSF
antibody titers
**PCR of CSF for Herpes Encephalitis

Question 18

What are these signs & symptoms of?

headache
*focal neurologic deficits
*fever, chills and other signs of infection usu do not occur
papilledema
nausea, vomiting

Answer 18

brain abscesses

Question 19

What are treatment options for a brain abscess?

Answer 19

antibiotics

surgical drainage

Question 20

When to do a lumbar puncture?

Answer 20

suspected cases of meningitis & encephalitis
if severe headaches, MS, subarachnoid hemmorrhage
can also be used as a treatment if pt has increased ICP or pseudotumor cerebri

Question 21

What are some complications of lumbar punctures?

Answer 21

spinal headache
nerve damage
back pain
infection or bleeding *rare

Question 22

When NOT to do a lumbar puncture?

Answer 22

pt refuses
skin infection or abscess
bleeding disorder
space occupying lesion

Question 23

Both bacterial and viral meningitis have these symptoms

Answer 23

fever
headache
meningismus