L8: Neuro emergencies: Stuff in Red

Question 1

Bacterial meningitis is a _____

Answer 1

Neurologic emergency

Question 2

N meningitides as a cause of bacterial meningitis

Answer 2

Enters in nasopharynx
All ages
No risk factors

Question 3

S pneumoniae as a cause of bacterial meningitis

Answer 3

Enters in nasopharynx, skull fractures, contiguous or distant infection

Question 4

Bacterial meningitis can present

Answer 4

Progressively (days)
Or
Acutely (hours)

Question 5

Classic triad for bacterial meningitis

Answer 5

Fever
Nuchal rigidity
AMS

Question 6

Gold standard for diagnosis of bacterial meningitis

Answer 6

CSF culture

Question 7

CT scan BEFORE LP forr…

Answer 7

Immunocompromised state
History of CNS disease
New onset seizure
Papilledema
Abnormal level of consciousness
Focal neurologic deficit
↑ ICP→ mass lesion→ cerebral herniation during LP

Question 8

G+ diplococci

Answer 8

pneumococcal infection

Question 9

G- diplococci

Answer 9

meningococcal infection

Question 10

G- coccobacilli

Answer 10

H influenzae infection

Question 11

G+ rods and coccobacilli

Answer 11

L monocytogenes

Question 12

Management of bacterial meningitis

Answer 12

do not delay tx
initiate dexamethazone and empiric IV abx immediately after blood cultures and LP

(if LP delayed, then after blood cultures)

Question 13

Newborn + bacterial meningitis gets

Answer 13

Ampicillin

+cef or genta

Question 14

1-23 months + bacterial meningitis gets

AND

2-20 years + bacterial meningitis gets

Answer 14

Vancomycin

+cef + dexa

Question 15

Older than 50 + bacterial meningitis gets

Answer 15

Ampicillin + Vancomycin

+cef + dexa

Question 16

Alternative to ampicillin if a bacterial meningitis patient has PCN allergy

Answer 16

Vancomycin + Moxifloxacin + Bactrim

Question 17

Basilar skull fracture + bacterial meningitis gets

Answer 17

Ampicillin

+ cef or genta

Question 18

Penetrating trauma/post-neurosurgery + bacterial meningitis gets

Answer 18

Vancomycin

+cef or meropenem

Question 19

Dexamethasone only helps

Answer 19

Pneumococcal meningitis

Only continue it if (+) stain/cultures

Question 20

Aseptic meningitis on labs

Answer 20

negative bacterial cultures

Question 21

Most common viral cause of aseptic meningitis

Answer 21

Enterovirus
(coxsackie, echovirus)

Also HSV-2

Question 22

Blurred lines between meningitis and encephalitis

Answer 22

meningoencephalitis

Question 23

Most common cause of encephalitis in US

Answer 23

West Nile Virus

Question 24

Most common cause of fatal encephalitis

Answer 24

HSV-1

most important to identify and treat

Question 25

Rarely seen with encephalitis, but may be seen with meningoencephalitis

Answer 25

Photophobia

Nuchal rigidity

Question 26

RBC in CSF

Answer 26

HSV-1 encephalitis

Question 27

For etiology of a cerebral abscess

Answer 27

consider it’s location

Question 28

Unilateral headache

Answer 28

Cerebral abscess

Question 29

Oral source of cerebral abscess treatment

Answer 29

Metronidazole + Penicillin G

Question 30

Otogenic or sinus source of cerebral abscess treatment

Answer 30

Metronidazole
 \+
Ceftriaxone
OR
Cefotaxim

Question 31

Spinal epidural abscess treatment

Answer 31

Vancomycin + cef

4-8 weeks

Question 32

immuncompromised + bacterial meningitis gets

Answer 32

Ampicilin + Vancomycin

+ cef or merropenem + Dexa

Question 33

Who ~doesn’t~ get dexamethasone for bacterial meningitis?

Answer 33

Newborns

Question 34

Vancomycin covers…

Answer 34

MRSA

Question 35

Ampicillin covers..

Answer 35

Listeria