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Neuro Unit 2 > Infections of the CNS > Flashcards

Infections of the CNS Flashcards

1
Q

Why is the incidence of meningitis decreasing?

A

Hib, pneumococcus, and meningococcus A, C, W135, Y vaccines

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2
Q

Where is bacterial meningitis located?

A

In the subarachnoid space. In very severe cases, swelling can affect cortex

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3
Q

What is the pathogenesis of bacterial meningitis?

A

Bloodstream, adjacent intracranial infection, skull/spinal defects

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4
Q

What

A

Increased BBB permeability, leading to swelling and higher ICP.
Severe disease can cause vasculitis or infarction
Interferes with CSF circulation (hydrocephalus)
Pron-inflammatory cytokines lead to edema

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5
Q

What is the classic triad with meningitis?

A

fever, depressed consciousness, stiff neck

Also: h/a, CNS findings

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6
Q

What is the Kernig sign?

A

???????

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7
Q

What is the ?????sign?

A

???????

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8
Q

When should antibiotics be started in meningitis

A

within 60 minutes of arriving to emergency room

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9
Q

What is the workup fo meningitis?

A

blood cultures, LP, empiric antibiotics, neuroimaging

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10
Q

What is the key diagnostic procedure for bacterial meningitis?

A 
LP
Open P: 200-500
CSF pleocytosis: 1000-5000
%PMNs >80%
Protein: 100-500 (high due to inflammation)
Glucose
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11
Q

What is the sensitivity of gram stain?

A

60-90%

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12
Q

What is the sensitivity of LP?

A

70-85%

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13
Q

When should a lumbar puncture not be performed prior to neuroimaging?

A

Get blood cultures and begin empiric antibiotics before neuroimaging
Don’t want to cause herniation
Focal neurologic deficit/altered consciousness
Signs of ICP (papilloedema)
Suspected focal CNS infection/lesion
Immunocompromised (more worried about CNS lesions)

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14
Q

What neuroimaging should be done?

A

Whichever is faster. MRI is slightly better

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15
Q

What are the most likely bugs involved in meningitis during the neonatal period?

A 
Group B strep
E. coli
Strep pneumoniae (pneumococcus)
Neisseria Meningitidis (meningococcus)
Listeria Monocytogenes (early or late in life, alcoholics- requires ampicillin)
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16
Q

What are the most likely bugs involved in meningitis during ages 2-23 months?

A 
Group B strep
E. coli
H. Flu
Strep pneumoniae (pneumococcus)
Neisseria Meningitidis (meningococcus)
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17
Q

What are the most likely bugs involved in meningitis during ages 2-35 years?

A 
Neisseria Meningitidis (meningococcus)
Strep pneumoniae (pneumococcus)
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18
Q

What are the most likely bugs involved in meningitis during over 35 years?

A 
Strep pneumoniae (pneumococcus)
Neisseria Meningitidis (meningococcus)
Listeria Monocytogenes (early or late in life, alcoholics- requires ampicillin)
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19
Q

What is the empiric therapy for bacterial meningitis in neonates?

A

?????

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20
Q

What is the empiric therapy for bacterial meningitis in children >2 months?

A

?????

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21
Q

What is the empiric therapy for bacterial meningitis in adults?

A

???????

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22
Q

Intracellular gram negative diplo cocci?

A

Meningococcus

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23
Q

What are the gram stain findings for the different bacteria types involved in meningitis

A

???????????

24
Q

When should steroids be intiated

A

Before starting antibiotics. Usually dexamethasone given prior to or simultaneously with first dose of antibiotics

25
Q

What are some complications of acute bacterial meningitis

A

Someone gets better, then starts getting worse
Decline in consciousness:
meningoencephalitis
Cranial nerve palsy (most often VIII)
Seizures or nonconvulsive status epilepticus
Subdural empyema
acute hydrocephalus
cerebral infarcts due to septic arteritis or endarteritis obliterans, venous thrombophlebitis, thromboemboli

26
Q

When should you repeat LPs?

A

Not getting better, PCN resistant pneumococcus, gram negative rods and listeria

27
Q

What are the main causes of viral meningitis?

A

Enteroviruses, HSV-2

Also: VZV,

28
Q

What are the main causes of viral encephalitis?

A

WNV, HSV-1

29
Q

What does the CSF look like with a viral CNS infection?

A

Mostly lymphocytes (PMNs early in some-WNV)
normal glucose
normal protein
PCR positive

30
Q

What is the treatment for enterovirus?

A

No FDA approved therapy

31
Q

What does the CSF look like with a viral CNS infection?

A

Mostly lymphocytes (PMNs early in some-WNV)
normal glucose
normal protein (elevated in HSV)
PCR positive

32
Q

What are clues that the virus is enterovirus?

A

rash, pharyngitis/herpangina, GI, pleurodynia, myocarditis, pericarditis, conjunctivitis

33
Q

What is the treatment for HSV meningitis?

A

Valacyclovir or acyclovir

34
Q

What is the most common cause of encephalitis

A

HSV

35
Q

What is autoimmune encephalitis?

A

Anti-NMDA receptor encephalitis- CSF profile looks like viral encephalitis.

36
Q

How does HSV cause encephalitis?

A

HSV hangs out in the trigeminal ganglion. Can possibly go up the olfactory nerve to the bulb. Also possibly for sensory tract.

37
Q

What are the signs and symptoms of HSV encephalitis?

A

Altered consciousness, fever, h/a, seizures, focal signs (less common)

38
Q

How does acyclovir work?

A

Viral tyrosine kinase phosphorylates acyclovir making it active

39
Q

What are arboviruses?

A

Spread by mosquitos and ticks- WNV, zika virus

40
Q

What happens with WNV?

A

Virus infects local inflammatory cells, and spreads infection along the inflammatory pathway, spreading to the lymph nodes.

41
Q

What symptoms are associated with WNV meningoencephalitis?

A

Fever, h/a, nuchal rigidity
nausea, vomiting, neck pain
?????????????????????????

42
Q

What symptoms are associated with WNV meningoencephalitis?

A

Fever, h/a, nuchal rigidity
nausea, vomiting, neck pain, myalgia
low back pain
tremor

?????????????????????????

43
Q

What does imaging look like in WNV and HSV

A

MRI is very sensitive for HSV - frontal or temporal lobes, but WNV MRI looks completely normal- will cause issues in deep grey nuclei

44
Q

Where are the MRI findings in the different viral meningitis?

A

???????????

45
Q

How is WNV detected?

A

IgM serology. CSF IgM antibody for WNV. cross-reacts with yellow fever, zika

46
Q

How is HSV detected?

A

PCR

47
Q

What does CSF look like in WNV?

A

Pleocytosis up to >2000 cells
PMNs can predominate early
Reactive lymphocytes
?????????????????????

48
Q

What is the therapy for WNV?

A

Not much.

49
Q

How can you be exposed to toxoplasmosis?

A

Eating cat poop

50
Q

What is the presentation of toxoplasmosis?

A

h/a, fever, confusion, lethargy, seizures, or focal neurologic signs

51
Q

How do you diagnose toxoplasmosis?

A

????????????

52
Q

How do you treat toxoplasmosis?

A

bactrim or sulfa-based therapy

53
Q

What organisms cause basilar meningitis?

A

????????????

54
Q

How do you diagnosis cryptococcus?

A

CSF cryptococcal antigen (CRAG)

55
Q

What is the clinical presentation of cryptococcus?

A

???????????

56
Q

What does CSF look like in cryptococcus?

A

???????

57
Q

What is the treatment for cryptococcus?

A

Amphoterecin and fluconazole

Make sure LP opening pressures continue to decrease

Neuro Unit 2 (21 decks)

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