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SBM neurology > Infections of CNS - bacterial meningitis and miscellaneous bacterial infections > Flashcards

Infections of CNS - bacterial meningitis and miscellaneous bacterial infections Flashcards

1
Q

how do bacteria reach the subarachnoid space?

A
  • blood stream
  • sinus
  • ears
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2
Q

what causes edema in bacterial meningitis?

A
  • toxins from bacteria or from leukocytes
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3
Q

bacterial meningitis presentation

A
  • change in alertness
  • headache
  • fever
  • stiff neck resistant to flexion
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4
Q

how diagnose bacterial meningitis?

A

LP

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5
Q

WBCs in bac meningitis

A
  • usually 1000cells/cu mm or more and mostly PMNs

- early in disease WBC count can be low and can be mostly lymphocytes

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6
Q

protein and glucose in bac meningitis

A

high protein, low glucose

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7
Q

when start antibiotics in bac meningitis?

A

right away, it’s an emergency, and LP will be good even if taken hours after starting antibiotics

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8
Q

most common pathogen in bac meningitis in neonates?

A

group B beta-hemolytic streptococci and enteric gram-negative bacilli are the most common pathogens, accounting for 60-70% of the cases of meningitis.

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9
Q

most common pathogen in bac meningitis in 2 month to ten year olds?

A

“Hemophilus influenzae, meningococci, or pneumococci.”

Excerpt From: “Disorders of the Nervous System.” iBooks.

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10
Q

what should we think about if there are unusual organisms?

A

immune deficiency

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11
Q

treatment for group B-beta hemolytic strep

A

penicillin

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12
Q

treatment for enteric gram negative bacilli

A

3rd gen cephalosporin

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13
Q

treatment for listeria

A

ampicillin or penicillin

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14
Q

treatment for H. influenza

A

penicillin

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15
Q

treatment for meningococcal meningitis

A

amp or chloremphenicol

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16
Q

ten complications of acute bacterial meningitis

A
  • Cerebral edema (may lead to herniation)
  • Vasculitis
    Arteritis (stroke)
    Cortical venous thrombosis (stroke, seizures)
    Venous sinus thrombosis (increased intracranial pressure)
  • Hydrocephalus
  • Cranial nerve palsies
  • Subdural effusion or empyema
  • Disseminated intravascular clotting (purpura, cyanosis, pain, fever, and hypotension)
  • Lactic acidosis
  • Inappropriate ADH secretion (hyponatremia)
  • Diabetes insipidus
  • Residual findings
    Cranial nerve palsies
    Mental retardation
    Seizures
17
Q

causes of intracranial pressure in bac meningitis

A
  • reduced resorption of CSF due to inflammation of the sinuses
  • damage to arachnoid granulations
  • ## in infants - subdural effusion
18
Q

what causes DIC in bac meningitis?

A

vasculitis with intravascular deposition of fibrin

19
Q

treatment of DIC in bac meningitis

A
  • steroids in children

- possibly heparin

20
Q

treatment of lactic acidosis in bac meningitis

A
  • bicarb
21
Q

presentation of bac meningitis in Lyme disease

A
  • weeks after infection but often when rash is still present

- often accompanies damage to the facial nerve

22
Q

array of presentations of neurosyphilis

A
  • meningitis
  • vasculitis and CNS infarction
  • tertiary syphilis
23
Q

two presentations of tertiary syphilis

A
  • tabes dorsalis

- general paresis

24
Q

symptoms of tabes dorsalis in tertiary syphilis

A
  • inflammation of dorsal root ganglia
  • loss of position and vibration sense
  • loss of deep tendon reflex
  • lightning pain to abdomen
  • abdominal cramps and vomiting
  • Argyll-Robertson pupil, small and irregular with no light reaction but with accommodation
  • bladder dysfunction
25
Q

symptoms of general paresis in tertiary syphilis

A
  • infection of frontal lobes of cerebral cortex
  • frontal lobe dementia
  • pupillary changes, myoclonic jerks, tremor
26
Q

what tests can be used to diagnose neurosyphilis?

A
  • rapid plasma reagin (RPR)
  • venereal disease research lab test (VDRL)
  • fluorescent treponemal antibody test (FTA)
27
Q

which test can confirm tertiary syphilis?

A
  • only FTA
28
Q

what spirochete is responsible for lyme disease?

A

borrelia burgdorferi

29
Q

what is a common misdiagnosis in lyme disease parenchymal lesions?

A
  • MS

- the lesions can occur with a fluctuating corset

30
Q

which cranial nerve is most often affected by lyme disease?

A

VII

31
Q

treatment of lyme disease

A

doxycyclin or amoxicillin, more successful earlier

32
Q

rickettsial infection presents with

A
  • non-specific meningoencephalitis
  • headache, stiff neck, lethargy are often the first signs
  • tick bite and associated rash
33
Q

rickettsial infection treatment

A

tetracycline or chloramphenicol

34
Q

4 common infant bacterial infections

A

E. coli
group B strep
staph
listeria

35
Q

3 common child bacterial infections

A

H influenza
meningococcus
pneumococcus

36
Q

2 common adult bacterial infections

A

meningococcus

pneumococcus

37
Q

3 common elderly bacterial infections

A

H influenza
pneumococcus
listeria

SBM neurology (22 decks)

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