Meningitis and Encephalitis Flashcards
Pathogonomic sign of meningeal irritation Harrison pp 883
Nuchal rigidity
Thigh is flexed against the abdomen with knee is also flexed, attempt to passively extend the knee and elicit pain when meningeal irritation is present.
Harrison pp 883
Kernig sign
Passive flexion of the neck. Result in spontaneous flexion of the hips and knee. Harrison pp 883
Brudzinski’s sign
What type of patient should undergo CT scan/MRI prior to lumbar puncture (LP)? Harrison pp 884
Head trauma Immunocompromised (Malignant lesions or CNS) Focal neurologic findings Papilledema Depressed level of consciousness
What does not occur in viral meningitis? Harrison pp 884
Decreased level of consciousness
Seizures
Focal neurologic deficit
If MRI showed focal or generalized gray matter abnormalities or normal and no mass lesions, it is more of what disease? Harrison pp 884
Encephalitis
If MRI/CT showed, no mass lesion but noted white matter abnormalities? Harrison pp 884
Acute Dissiminated Encephalomyelitis
Most often responsible for community acquired bacterial meningitis? Harrison pp 885
Streptococcus pneumoniae
Neisseria meningitis
Group B streptococci
Causative organism of recurring epidemics of meningitis. Harrison pp 885
N. Meningitis
Risk factor associated with S. pneumoniae meningitis. Harrison pp 885
Most important: pneumococcal pneumoniae
- Acute or chronic pnuemococcal sinusitis or otitis media
- Alcoholism
- Diabetes
- Splenectomy
- Hypogammaglobulinemia
- Complement deficiency
- Head trauma w/ basilar skull fracture
- CSF Rhinorrhea
Risk factor for gram negative bacilli in meningitis Harrison pp 885
Chronic and debilatating disease such as diabetes, cirrhosis, alcoholism and chronic UTI
Commonly affected by L. monocytogenes Harrison pp 885
< 1month of age
pregnant woman
immunocompromised
> 60 years of age
These are important causes of meniningitis that occurs following invasive neurosurgical procedures like shunting procedures for hydrocephalus or as a complication secondary use of subcutaneous ommaya reservoir. Harrison pp 885
S. aureus
Coagulase negative staphylococci
Reasons why bacteria are able to multiply rapidly w/in CSF. Harrison pp 886
- absence of effective host immunodefense
- small amount of complement proteins
- fluid nature of CSF
What are the clinical triad of meningitis? Harrison pp 887
- Fever
- Headache
- Nuchal Rigidity
It occurs as part of the initial presentation of bacterial meningitis or during the course of the illness in 20-40% of patients. Harrison pp 887
Seizures
What are the signs of increased ICP? Harrison pp 887
- decreased level of consciousness
- papilledema
- Dilated poorly reactive pupils
- 6th nerve palsies
- Decerebrate posturing
- Cushing reflex
Cushing reflex
Harrison pp 887
Bradycardia
Hypertension
Irregular respiration
Define the rash of meningococcemia. Harrison pp 887
Begins as a diffuse erythematous maculopapular rash resembling viral exanthem. Then rapidly becomes petechial that found at the trunk and lower extremities , mucous membranes and conjunctiva.
Classic CSF abnormalities in bacterial meningitis. Harrison pp 887
- leukocytosis (>100 cells/ul in 90%)
- decrease glucose concentration (40mg/dl)
- CSF/serum glucose ratio <0.5 in 60%
- Increase protein concentration of >45mg/dl
- Increased opening pressure > 180mmH20
- CSF bacterial cultures are positive >80%
- CSF gram’s stain demonstrate > 60%
Antibiotic use for hospital acquired meningitis post traumatic or post surgery meningitis, neutropenic patients, or patient with impaired cell-mediated immunity. Harrison pp 887
Ampicillin + Ceftazidime or Meropenem + Vancomycin
Antibiotic use > 55 years old and adult of any age with alcoholism or other debilatating illness. Harrison pp 887
Ampicillin + cefotaxim, ceftriaxone or cefepime + vancomycin
It is rapid diagnostic test for the detection of gram-negative endotoxin CSF. Harrison pp 888
Limulus amebocyte
Lysate assay
What is the antibiotic of choice of meningococcal meningitis? Harrison pp 888
Pen G
