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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
how is bacterial meningitis spread
respiratory/throat secretions prolonged/close contact - day cares - military - sports teams mother to infant
26
what are the 3 most common rapid onset clinical features
high fever severe HA stiff neck (nuchal rigidity)
27
what about bacterial meningitis' clinical presentation can help you differentiate from viral meningitis
acute abrupt onset in bacterial
28
why can you see papilledema in bacterial meningitis
swelling of optic disc d/t inc ICP --> visible when light shown into eye
29
what are ALL the clinical features of bacterial meningitis
high fever (103-104) severe HA nuchal rigidity altered level of consciousness convulsions (in children) n/v photophobia papilledema
30
what are risk factors for bacterial meningitis
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
31
how is bacterial meningitis dx
clinical presentation kernig sign & brudzinski sign lumbar puncture blood culture MRI/CT
32
what are kernig and brudzinski signs
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
what results of a lumbar puncture indicate bacterial meningitis
high opening pressures CSF has inc protein and dec glucose
34
why are blood cultures taken for bacterial meningitis
look for infectious agent in blood stream
35
when and why are MRI/CTs taken in bacterial meningitis
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
what are medical management techniques for bacterial meningitis
antibiotics sx management - ICP monitor/mgmt - airway protection - edema (dexamethosone) - sz (anticonvulsants) - IV fluids
37
what is a person w bacterial meningitis at high risk for in first few days and why
acute ischemic stroke - creates environment where there is more coagulation
38
what sequelae are seen in bacterial meningitis
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
what is the most common type of meningitis
viral / aseptic
40
dz course in viral/aseptic meningitis vs bacterial
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
what is viral / aseptic meningitis
non-purulent inflammatory process
42
what are the 3 most common infectious agents responsible for viral / aseptic meningitis
non-polio enteroviruses herpes viruses HIV
43
what are the less common infectious agents responsible for viral / aseptic meningitis
measles mumps influenza west nile virus lyme borrelia
44
what is the usual duration of viral/aseptic meningitis sx
7-10days
45
what are sx of viral / aseptic meningitis
irrritability, photophobia lethargy, sleepy, difficulty waking HA, nuchal rigidity **low grade fever n/v, poor appetite
46
viral meningitis sx vs bacterial
less severe in viral see a more low grade fever
47
how is viral / aseptic meningitis spread
direct contact w stool, respiratory secretions, or via droplets
48
how is viral / aseptic meningitis dx
lumbar puncture blood tests and cultures swab test/culture clinical sx
49
what results of a lumbar puncture indicate viral meningitis
elevated WBC count elevated protein levels NORMAL GLUCOSE LEVELS* ** this will be dec in bacterial
50
what is looked for when doing swab test/cultures in viral meningitis
looking for enterovirus/infections leading to meningitis to treat - swabbing nose, throat, and rectum
51
what is the prognosis for viral meningitis
good full recovery w/i days to few weeks
52
what are medical management techniques for viral meningitis
medication for sx relief antiviral meds - herpes, flu rest fluid
53
what are medical management techniques for viral meningitis
medication for sx relief antiviral meds - herpes, flu rest fluids
54
what is the most common form of meningitis in developing nations
fungal
55
what cases have we seen of fungal meningitis in the US
from bird and bat droppings in Midwest - in people w compromised immune systems
56
what is the gold standard of treatment for fungal meningitis
IV doses of antifungal meds
57
risk factors and s/sx of fungal meningitis are analogous to what? what is a big distinguishing factor?
viral meningitis fungal can be fatal
58
spreading / pathophys of how you can contract fungal meningitis
naturally occurring fungal spores inhaled or ingested spores enter bloodstream cross BBB and infect brain and SC tissue
59
what is encephalitis
inflammation of parenchyma (supporting neural structures - ie neurons and glial cells) & surrounding meninges
60
what are neurologic sequelae seen from encephalitis dependent on
the type of encephalitis
61
what is the most common etiology of encephalitis
viral
62
what are the types of encephalitis
acute viral - herpes parainfectious - measles, mumps, varicella progressive viral - immunosuppressed - perinatal transmission other - more rare, fatal - contaminated food
63
what is the pathophys of encephalitis
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
s/sx of encephalitis
tends to be widespread, don't tend to see focal neuro deficits fever HA nuchal rigidity vomiting general malaise confusion / cog changes irritability
65
how will severe forms of encephalitis present
coma CN palsies hemiplegia ataxia
66
how is encephalitis dx
travel hx check for insect bites comprehensive neuro exam blood test CT, MRI EEG lumbar puncture brain biopsy
67
what is looked for in the blood test for encephalitis
antibodies to virus can be detected
68
what lumbar puncture results will help confirm encephalitis
inc WBC
69
what will show up on MRI for encephalitis
whitening of sulci indicates death of neurons and inflammation (global effects)
70
what are medical management options for encephalitis
ICP management antiviral med (HSV infection) sx relief hydration anti-epileptic drugs steroids palliative care
71
when is palliative care a consideration in encephalitis
when there has been severe destruction of CNS
72
what are neurologic sequelae of encephalitis
cog deficits CN palsy inc ICP --> hydrocephalus hemi -plegia/-paresis ataxia sensory deficits aphasia, dysarthria
73
what are cognitive deficits sequelae seen after encephalitis
coma confusion memory loss dementia type behaviors
74
what CN palsies sequelae seen after encephalitis
hearing loss vestib loss gaze preference
75
what sx are associated w encephalitis sequelae regarding inc ICP leading to hydrocephalus
impaired gait mental status chage incontinence HA n/v vision changes
76
what are PT considerations for infectious dz of CNS
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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