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Neuro Rehab 2 > Infectious Diseases of CNS > Flashcards

Infectious Diseases of CNS Flashcards

1
Q

what are 3 classifications of brain abscesses

A

bacterial
fungal
parasitic

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2
Q

what are 3 classifications of meningitis

A

bacterial
viral
fungal

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3
Q

what are 3 classifications of encephalitis

A

acute viral
para-infectious encephalopathy

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4
Q

what are predisposing factors for brain abscesses

A

dec immune system
- HIV
- CA and chemo

congenital heart defects
- TOF, murmurs
- abnormal flow, things can collect and spread

chronic corticosteroid use
injury
surgery

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5
Q

what are 3 etiologies of brain abscesses

A

penetrating wound to brain, brains surgery

contiguous infection (sinusitis, ear infection, oral/tooth infections) - importance of dental hygiene

bacteremia - spread from infection in remote region such as lungs, heart, skin

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6
Q

what is the pathophys of a brain abscess

A

immune cells, dead cells, and microorganisms collect and become encapsulated

contains infection but can exert inc pressure on adjacent neural tissue, vasculature, and ventricles

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7
Q

what are neurologic manifestations of brain abscesses

A

inc ICP
seizures
vomiting

focal and global neuro deficits

gradual: fever, HA, lethargy, confusion, irritability

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8
Q

how can the onset of neurological manifestations of brain abscesses vary and why

A

can see rapid onset or slower, progressive course over weeks

nervous system can compensate until abscess reaches a certain size -> results in abrupt onset of sx that were previously suppressed

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9
Q

red vs yellow flag w brain abscesses

A

red - abrupt, acute onset
- sz w/o hx of epilepsy

yellow - insidious onset
- call MD

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10
Q

what pathology does brain abscesses have a similar workup to if abrupt onset

A

stroke

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11
Q

how is a brain abscess dx

A

ICP
MRI
EEG - if 1st sign is sz
CBC - looking for infection
needle biopsy - looks infection

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12
Q

what are medical management options

A

antibiotics (broad spectrum)
antifungals

surgery
- aspiration
- excision
- decompression
- shunting

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13
Q

surgical aspiration vs excision medical management of brain abscesses

A

aspiration
- remove fluid
- removes pressure on neuro structures

excision
- cut abscess out if it is superficial and more encapsulated

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14
Q

why might a shunt be place wen managing a brain abscess

A

manage ICP changes

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15
Q

when is surgery not indicated for brain abscesses

A

small, deep, or multiple abscesses

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16
Q

how can a brain abscess be fatal

A

if pressing on brainstem
–> press on bulbar areas (respiratory failure)

brainstem herniation

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17
Q

what inc the mortality rate of brain abscesses

A

delayed access to medical care

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18
Q

what are some neurological sequelae of brain abscesses

A

persistent sz
hemiparesis
speech/language disorders
permanent neuro damage

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19
Q

what is a long term physiological change as a result of a brain abscess

A

long term damage to electrical signaling of brain

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20
Q

what is meningitis

A

inflammation of meninges w CSF infection

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21
Q

what are potential etiologies of meningitis

A

penetrating wounds, brain and other surgery, VP shunt

systemic infections - travel thru blood and cross BBB

CA- neoplastic meningitis
- tumors can cause infection and swelling of meninges

drug allergies
- NSAIDs, antibiotics

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22
Q

what are the impacts of inflamed meninges with meningitis

A

CSF circulates in subdural space
- can cause issues w ICP and w HA, gait, and visual disturbances

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23
Q

is bacterial meningitis preventable

A

yes, very!

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24
Q

what is the pathophysiology of bacterial meningitis

A
  1. circulating infectious organism
  2. crosses BBB
  3. purulent exudate in subarachnoid space
  4. inflammation of meninges
  5. obstructed CSF flow
  6. inc ICP –> hydrocephalus

leading to global neuro dysfunction
risk of brainstem herniation if continues

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25
Q

how is bacterial meningitis spread

A

respiratory/throat secretions
prolonged/close contact
- day cares
- military
- sports teams
mother to infant

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26
Q

what are the 3 most common rapid onset clinical features

A

high fever
severe HA
stiff neck (nuchal rigidity)

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27
Q

what about bacterial meningitis’ clinical presentation can help you differentiate from viral meningitis

A

acute abrupt onset in bacterial

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28
Q

why can you see papilledema in bacterial meningitis

A

swelling of optic disc d/t inc ICP –> visible when light shown into eye

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29
Q

what are ALL the clinical features of bacterial meningitis

A

high fever (103-104)
severe HA
nuchal rigidity
altered level of consciousness
convulsions (in children)
n/v
photophobia
papilledema

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30
Q

what are risk factors for bacterial meningitis

A

ages <5 or >60
alcoholism
sickle cell anemia
CA, chemo
organ transplant
DM
HIV infection
skull fx, TBI
living in close quarters
IV drug users
VP shunt placement

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31
Q

how is bacterial meningitis dx

A

clinical presentation
kernig sign & brudzinski sign
lumbar puncture
blood culture
MRI/CT

32
Q

what are kernig and brudzinski signs

A

screening tools which both put passive traction on meninges to see if elicit pain

kernig = traction on long nerves and meninges in SC

brudzinski = person will reflexively flex hips and knees to take traction off

33
Q

what results of a lumbar puncture indicate bacterial meningitis

A

high opening pressures
CSF has inc protein and dec glucose

34
Q

why are blood cultures taken for bacterial meningitis

A

look for infectious agent in blood stream

35
Q

when and why are MRI/CTs taken in bacterial meningitis

A

before lumbar puncture

to r/o mass effect
- if suspect elevated ICP, want to avoid quick change in pressure that could pull down on neural structures and potentially lead to brainstem herniation

36
Q

what are medical management techniques for bacterial meningitis

A

antibiotics
sx management
- ICP monitor/mgmt
- airway protection
- edema (dexamethosone)
- sz (anticonvulsants)
- IV fluids

37
Q

what is a person w bacterial meningitis at high risk for in first few days and why

A

acute ischemic stroke
- creates environment where there is more coagulation

38
Q

what sequelae are seen in bacterial meningitis

A

septicemia resulting in:
- tissue damage
- loss of limbs
- organ failure
- death

CN palsies (often CN VIII)
- sensorineural hearing loss
- vestib dysfunction

communicating hydrocephalus with:
- abnormal gait
- mental status changes
- incontinence

ms weakness, spasticity
hemiparesis
sz
ataxia
cog dysfunction

39
Q

what is the most common type of meningitis

A

viral / aseptic

40
Q

dz course in viral/aseptic meningitis vs bacterial

A

viral: more benign
- lower mortality
- lower morbidity
- often don’t see septicemia
- less edema
- dec risk of inc ICP and hydrocephalus
- often self limiting

= better prognosis

41
Q

what is viral / aseptic meningitis

A

non-purulent inflammatory process

42
Q

what are the 3 most common infectious agents responsible for viral / aseptic meningitis

A

non-polio enteroviruses
herpes viruses
HIV

43
Q

what are the less common infectious agents responsible for viral / aseptic meningitis

A

measles
mumps
influenza
west nile virus
lyme borrelia

44
Q

what is the usual duration of viral/aseptic meningitis sx

A

7-10days

45
Q

what are sx of viral / aseptic meningitis

A

irrritability, photophobia
lethargy, sleepy, difficulty waking
HA, nuchal rigidity
**low grade fever
n/v, poor appetite

46
Q

viral meningitis sx vs bacterial

A

less severe
in viral see a more low grade fever

47
Q

how is viral / aseptic meningitis spread

A

direct contact w stool, respiratory secretions, or via droplets

48
Q

how is viral / aseptic meningitis dx

A

lumbar puncture
blood tests and cultures
swab test/culture
clinical sx

49
Q

what results of a lumbar puncture indicate viral meningitis

A

elevated WBC count
elevated protein levels

NORMAL GLUCOSE LEVELS*
** this will be dec in bacterial

50
Q

what is looked for when doing swab test/cultures in viral meningitis

A

looking for enterovirus/infections leading to meningitis to treat
- swabbing nose, throat, and rectum

51
Q

what is the prognosis for viral meningitis

A

good
full recovery w/i days to few weeks

52
Q

what are medical management techniques for viral meningitis

A

medication for sx relief
antiviral meds - herpes, flu
rest
fluid

53
Q

what are medical management techniques for viral meningitis

A

medication for sx relief
antiviral meds - herpes, flu
rest
fluids

54
Q

what is the most common form of meningitis in developing nations

A

fungal

55
Q

what cases have we seen of fungal meningitis in the US

A

from bird and bat droppings in Midwest
- in people w compromised immune systems

56
Q

what is the gold standard of treatment for fungal meningitis

A

IV doses of antifungal meds

57
Q

risk factors and s/sx of fungal meningitis are analogous to what? what is a big distinguishing factor?

A

viral meningitis

fungal can be fatal

58
Q

spreading / pathophys of how you can contract fungal meningitis

A

naturally occurring fungal spores inhaled or ingested

spores enter bloodstream

cross BBB and infect brain and SC tissue

59
Q

what is encephalitis

A

inflammation of parenchyma (supporting neural structures - ie neurons and glial cells) & surrounding meninges

60
Q

what are neurologic sequelae seen from encephalitis dependent on

A

the type of encephalitis

61
Q

what is the most common etiology of encephalitis

A

viral

62
Q

what are the types of encephalitis

A

acute viral - herpes
parainfectious
- measles, mumps, varicella
progressive viral
- immunosuppressed
- perinatal transmission
other - more rare, fatal
- contaminated food

63
Q

what is the pathophys of encephalitis

A
  1. viral invasion w damage to neurons and glial cells, edema & inflammation
  2. destruction of white matter by inflammation & thrombosis of perforating vessels
  3. inc ICP, cerebral edema, and vascular damage –> can have thrombotic stroke
64
Q

s/sx of encephalitis

A

tends to be widespread, don’t tend to see focal neuro deficits

fever
HA
nuchal rigidity
vomiting
general malaise
confusion / cog changes
irritability

65
Q

how will severe forms of encephalitis present

A

coma
CN palsies
hemiplegia
ataxia

66
Q

how is encephalitis dx

A

travel hx
check for insect bites
comprehensive neuro exam
blood test
CT, MRI
EEG
lumbar puncture
brain biopsy

67
Q

what is looked for in the blood test for encephalitis

A

antibodies to virus can be detected

68
Q

what lumbar puncture results will help confirm encephalitis

A

inc WBC

69
Q

what will show up on MRI for encephalitis

A

whitening of sulci indicates death of neurons and inflammation (global effects)

70
Q

what are medical management options for encephalitis

A

ICP management
antiviral med (HSV infection)
sx relief
hydration
anti-epileptic drugs
steroids
palliative care

71
Q

when is palliative care a consideration in encephalitis

A

when there has been severe destruction of CNS

72
Q

what are neurologic sequelae of encephalitis

A

cog deficits
CN palsy
inc ICP
–> hydrocephalus
hemi -plegia/-paresis
ataxia
sensory deficits
aphasia, dysarthria

73
Q

what are cognitive deficits sequelae seen after encephalitis

A

coma
confusion
memory loss
dementia type behaviors

74
Q

what CN palsies sequelae seen after encephalitis

A

hearing loss
vestib loss
gaze preference

75
Q

what sx are associated w encephalitis sequelae regarding inc ICP leading to hydrocephalus

A

impaired gait
mental status chage
incontinence
HA
n/v
vision changes

76
Q

what are PT considerations for infectious dz of CNS

A
  1. eval and treat mvmt dysfunction present
  2. survivors will have wide variety of neuro damage
  3. comprehensive initial neuro exam and re-assess
  4. consider LOC, med px, and cog status
  5. involve family (esp in peds)

Neuro Rehab 2 (48 decks)

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