Infections of the NS

Question 1

Which compartment is meningitis in?

Answer 1

Subarachnoid

Question 2

What is the cell responsible for innate immunity in the CNS?

Answer 2

Microglia

Question 3

Vasogenic edema

Answer 3

Swelling in the brain from an accumulation of fluid
Its the end point of a response to infection
Can cause neuronal injury, seizures, ischemia

Question 4

4 main symptoms of meningitis

Answer 4

Fever
Altered mental status
Neck stiffness (nuchal rigidity)
Headache

Question 5

The petechial/purpuritic rash is due to what bacteria?

Answer 5

N meningiditis

Question 6

Workup for meningitis

Answer 6

CBC, chemistries, coagulation, blood cultures (stat)
CXR
CT head
LP (dont have to wait to give the antibiotics for this)

Question 7

CSF analysis

Answer 7

Cell count
Protein
Glucose
Gram stain, culture
Viral PCR
Fungal/mycobacterial culture

Question 8

CSF findings for bacterial

1. Pressure
2. WBC
3. Protein
4. Glucose

Answer 8

1. Increased
2. Very high, mostly neutrophils
3. 10x increased normal
4. Decreased

Question 9

CSF findings for viral

1. Pressure
2. WBC
3. Protein
4. Glucose

Answer 9

1. Normal/increased
2. Increased
3. Normal/increased
4. Normal

Question 10

CSF findings for fungal

1. Pressure
2. WBC
3. Protein
4. Glucose

Answer 10

1. Increased
2. Increased, mostly lymphocytes
3. 2-3x increased normal
4. Normal/decreased

Question 11

4 high risk features that should make you do a CT before getting an LP

Answer 11

Immunocompromised
Depressed LOC/focally abnormal neuro exam
Seizures
Known mass lesion

Question 12

Initial drug management for suspected bacterial meningitis

Answer 12

Ceftriaxone
Vancomycin
Dexamethasone

Question 13

Why are we giving vancomycin?

Answer 13

For resistant streptococcus

Not for MRSA

Question 14

3 main complications of meningococcal meningitis

Answer 14

DIC
Severe sepsis/mortality
Permanent hearing loss

Question 15

Treatment of viral meningitis

Answer 15

Acyclovir

Question 16

Stroke vs encephalitis

Answer 16

Acute stroke causes sudden focal brain dysfunction

Encephalitis is more subacute, progressive and diffuse brain dysfunction with unexplained fever

Question 17

3 main symptoms of encephalitis

Answer 17

Fever
Confusion
Seizure

Question 18

Signs of a cerebral abscess

Answer 18

Fever
Headache
Focal signs referring to location (motor, sensory features, ataxia, cognitive dysfunction, aphasia, seizures)
Features of the mass effect (depressed LOC, papilledema)

Question 19

3 routes of infection causing an abscess

Answer 19

Otogenic (ear)
Odontogenic (mouth)
Hematogenous (heart)

Question 20

3 main symptoms of a epidural abscess

Answer 20

Fever
Back pain
Myelopathy (sensory level, sphincter disturbance, paraparesis, polyradiculopathy signs)