Meningitis Flashcards
MENINGITIS preview
Organism
- Enters via the bloodstream
- Migrates into the CSF
- Multiplies
- Begins the inflammatory response
- If viral: inflammation
- If bacterial: inflammation & exudate
- Exudate may spread to both cranial and spinal nerves
Meningitis Patho
- Inflammation of the arachnoid and pia mater of the brain and spinal cord caused from an infection of the meninges (the membranes that surround the brain and spinal cord)
β This inflammation can produce a wide range of symptoms and, in extreme cases, cause brain damage, stroke, or even death.
MENINGES
- MENINGES= 3 protective layers that cover the brain and spinal cord
- -itis= inflammation
- Meningitis= inflammation of the meninges (commonly the 2 inner layers known as leptomeninges)
Layers: - Dura mater (outer layer)
β Epidural space
β Subdural space - Arachnoid mater (middle layer) (leptomeninge)
β Subarachnoid space (space between the 2 leptomeninge layers)
β Houses CSF - Pia mater (inner layer)(leptomeninge)
MONROE-KELLIE DOCTRINE
- The cranium is a box
- The box contains blood, cerebrospinal fluid, and tissue
- The brain has the ability to self regulate
- Can alter fluid, blood flow, tissue
β head of bed up
β neck straight
Body has a mechanism that keep hemostasis (the give and take of needed blood)
Meningitis Risk factors/ cause
- Via the bloodstream from other infections
- Directly via penetration
β Basilar Skull fractures - Ruptured cerebral abscess
- Brain or spinal surgery
- Sinus and upper respiratory infections,
- Sepsis (hematogenous spread)
- Compromised immune system
- Viral, Bacterial: acute meningitis
- Fungal, Protozoa: chronic meningitis
Meningitis Cause: sepsis caused by Bacterial organisms
- *Neisseria meningitidis. (high mortality rate, often within 24 hours)
β droplet - transmitted by secretions or aerosol contamination, and infection is most likely in dense community groups such as college campuses
β initial meningococcal vaccine between 11 and 12 with a booster at 16 years. Adults are advised to get an initial or booster if living in shared living - *Streptococcus pneumoniae
β not airborne
Bacterial Meningitis Signs and Symptoms
- (can also have viral symptoms)
- Symptoms within 24 hours classic triad (fever, nuchal rigidity, more decreased LOC)
- High fever!
- Headache
- (+) Kernig sign
- (+) Brudzinski sign
- Behavioral changes
- SIADH (syndrome of inappropriate antidiuretic hormone)
- can be airborne
- Photophobia
- Rash and/or even septic emboli
Kernig Sign
Lift leg
Severe stiffness pain of the hamstring causes inability to straighten leg
Brudinskiβs Sign
Pain in neck
Causes knees to bend up
Meningitis Cause: aseptic caused by viral organisms
- secondary to cancer or a weak immune system
β Viral β herpes simplex virus 2 (HSV-2)
β Varicella zoster virus
β HIV
Viral Meningitis Signs and Symptoms
- Nuchal rigidity (stiff neck)
- Kernigβs sign (bend knee, pain in upper back)
- Brudzinski reflex
- Photophobia
- Fever, headache, chills
- LOC/orientation/memory
- Seizures
- Cranial Nerve dysfunction 3,4,6,7,8
β check pupils
β
Meningitis Cause: Fungal and protozoan (may also occur)
Cryptococcus neoformans
Meningitis diagnostics
- CT scan (rule out other stuff)
- Lumbar puncture (CSF)
- Bacterial culture
- Gram staining of CSF and blood
- Polymerase Chain Reaction (PCR): looks for HIV/ TB
Lumbar infection obtain and analyze
- Side lying position
- 3rd & 4th vertebrae
- Numb skin
- insert needle & collect sample
- band- aid
- lay flat supine for 6 hours
- Looking for bacterial or viral cause
- bacterial = cloudy
Cerebral spinal fluid (CSF)
- CSF is clear
- Contains little to no RBCs or WBCs
- Most drugs are too large to cross the BBB also
β hard to treat
Flow of cerebral spinal fluid:
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