Meningitis Flashcards

1
Q

Meningitis

A

Meninges of brain and spinal cord become inflamed

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2
Q

PCA and arachnoid become

A

Congested and opaque

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3
Q

Inflammation can extend

A

down into first and second laters of cortex and spinal cord producing thrombosis of cortical veins

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4
Q

Meningitis belt

A

Sub-Saharan Africa

Incidence is 5-10x higher

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5
Q

Most commonly affected

A

Children and older adults

Individuals w/ compromised immune system

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6
Q

Infection carried by

A

Blood products or other fluids and can case changes in cerebral capillary endothelium —> BBB rails to prevent enters into brain or CSF

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7
Q

Brain lacks

A

Lymphatic system to help fight infection

Leukocytes in the brain increase

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8
Q

Cells recruited to fight infection - damage

A

Surrounding brain tissue by release of cytotoxic free radicals and excitatory AA like glutamate

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9
Q

Response to inflammation

A

Can block the CSF creating hydrocephalus, edema and increased ICP

Vasculitis can lead to infarction

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10
Q

Decreased in vertebral blood flow

A

Can cause a drop in glucose levels of CSF

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11
Q

Viral meningitis

A

Most common — enterovirusus, herpes simplex virus 2, EBV in adolescence/early adult

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12
Q

Other causes of viral meningitis

A

Systemic lupus
Sarcoid tumors
Drugs/chemicals (NSAIDS)

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13
Q

Tuberculous meningitis

A

Mycobacterium TB via inhalation

Abscess or SC disease

Cysts and lymphocytes + elevated protein levels

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14
Q

Bacterial meningitis

A

Organisms located in Mucosal surfaces of upper respiratory ‘

Bacteria in birth canal can transfer

Neonates: Strep, eschericha coli, listeria monocytogenes,

Geriatric: strep pneumoniae, neisseria meningitis

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15
Q

Bacterial meningitis process

A

Inflammation initially in subarachnoid then spreads to adj brain tissue —>

vasculitis starts in small subarachnoid vessels —>

thrombin obstruction can decrease cerebral perfusion resulting in ischemic lesions

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16
Q

Early symptoms

A

Fever
HA
Stiff and painful nick

Pain in lumbar areas and posterior aspects of thigh

17
Q

Kernig sign

A

Pain w/ combined hip flexion and knee ext

18
Q

Brudzinski test

A

Passive neck flexion will be painful and cause flexion of hips and knees

19
Q

S/S in infants and children

A
Fever
Vomiting
Decreased feeding
Bulging font Anel’s
Seizure
High pitched cry
20
Q

Symptoms develop in

A

Hours for viral

Days to weeks, fungal or tuberculous

Pyogenic bacteria - S/S can develop in 4-24 hours

21
Q

Only definitive means of obtaining dx

A

Lumbar puncture—>

Elevated mono nuclear cells
Normal glucose level
Mild increase in protein levels
Absence of bacterial organism

22
Q

W/out antibiotics

A

Death can occur — prompt dx ciritical

23
Q

Most common cause in children

A

Viral infection

24
Q

Differentiation from bacterial and viral

A

Basis of S/S and changes in CSF

25
Dx accuracy
Gram stain exam of CSF faster, less expensive and 90% accurate
26
Open pressure - bacterial meningitis
200-500 mm H2)
27
Normal open pressure
70-180
28
Cell predominance
Neutrophils or lymphocytes
29
To when actue bacterial suspected
Anti micro bias therapy. ASAP Medical emergency, esp in children
30
Dexamethasone
Can reduce subarachnoid inflammatory response, alleviate cerebral edema and vasculitis
31
Death usually occurs
In the first two weeks
32
Cranial nerve palsies
30% of the time —> hearing impairment
33
Neuro complications
75% w/ bacterial Impaired consciousness, seizures, focal neuro abnormalities
34
Children can develop long term
``` Hearing loss Blindness Developmental delay Hydrocephalus Hypothalamic dysfunctions Hemiparesis Quad/tetraparesis ```
35
Mortality rate for tuberculous meningitis
20-50%