Meningitis and Seizures Flashcards
what is a seizure?
- a transient occurrence of signs/symptoms due to abnormal excessive or synchronous neuronal activity in the brain
- an involuntary contraction of muscles caused by abnormal electrical brain discharges
what are typical motor phenomena associated with seizure definition?
- lip smacking
- eye deviation
- automatisms
- tonic, clonic, myoclonic, or ionic clonic activity
what are symptoms usually perceived by the patient with a seizure?
- problems with perception, emotion, memory
- deja vu or jamais vu
- fear or anxiety or elation
when do seizures in children peak in incidence?
-during neonatal period and infancy
what percentage of children will have febrile seizures?
5%
these are seizures associated with fevers
what percentage of children and adolescents are diagnosed with epilepsy?
1%
what can cause seizure activity?
- CNS disorder
- structural defect
- disorder that causes CNS dysfunction (injury, infection, electrolyte disturbance, toxins, brain tumor)
- unknown etiology
what are some neurological causes of altered level of consciousness?
- infection of the brain and meninges
- increased ICP
- trauma
- hypoxia
- poisoning
- seizures
- substance abuse
- endocrine or metabolic disturbances
- electrolyte imbalances
- acid-base imbalance
- brain tumor
- stroke
what is meningitis?
-inflammation of the meninges
what causes meningitis?
bacterial or viral infection
though the source of infection can occur anywhere, where is the most common source of infections that cause meningitis?
the respiratory tract
what is more common: bacterial or viral meningitis?
viral
which is more serious bacterial or viral meningitis?
bacterial
how does the initial infection occur in neonates with meningitis?
in the birth canal and spreads hematogenously
what are sources of secondary bacterial meningitis infections?
- otitis media
- nasal sinus infection
- CNS infection after head trauma or surgery
what are the three most common sources of meningitis in children between the ages of 2 months and 12 years?
- haemophilus influenza b
- streptococcus pneumoniae
- neisseria meningitis
what are the two most common causes of meningitis in neonates?
group B strep
ecoli
what happens in the development of bacterial meningitis?
- bacteremia often spreads the infection agent to CNS
- WBCs accumulate covering the surface of the brain
- exudate covers brain and brain becomes hyperemic and edematous
- if infection spreads to ventricles CSF can become obstructed and cause increased ICP and hydrocephalus
what characterized viral (aseptic) meningitis?
- headache
- fever
- irritability
- inflammation
- no bacteria grows when culture taken from cerebrospinal fluid but may be increased blood cells and proteins
how is viral meningitis treated?
- usually it spontaneously resolves within 10 days, however symptoms may be treated
- treat headache and fever
- make sure well hydrated and getting electrolytes
- if increased ICP, run less than 100% fluid maintenance
what is Brudzinski’s sign?
- a physical symptom of meningitis
- neck stiffness causes patient’s knees and hips to flex when neck is flexed
- occurs because of meningeal irritation
what is Kernig’s sign?
- a physical symptom of meningitis
- severe stiffness of the hamstrings caused by inability to straighten leg when hip flexed 90 degrees
- occurs because of meningeal irritation
what are some symptoms of meningitis?
- fever
- lethargy
- confusion
- irritability
- bulging fontanelles
- poor feeding or sucking
- high pitched cry
- apnea
- seizures
how is bacterial meningitis diagnosed?
- lumbar puncture (expect to see WBC in cerebrospinal fluids if bacterial)
- blood work
- CT
how is bacterial meningitis treated?
- antibiotics
- corticosteroids via IV (dexamethasone)
- fluid restriction (2/3 maintenance because of increased ICP)
- NPO (need strict ins and outs)
what is encephalitis?
- inflammation of the brain
- usually referring to inflammation caused by infection or toxin
what age group has the highest incidence of encephalitis?
-children under the age of 1
what are some causes of encephalitis?
- herpes simplex virus
- enterovirus
- epstein barr
- ticks
- mosquitos
- measles
- mumps
- chickenpox
- rubella
- mononucleosis
what is the mortality rate of untreated patients with herpes encephalitis?
70%
even with treatment mortality remains at 30%
how can neonatal herpes simplex virus encephalitis be prevented?
- by performing c-section delivery if mother has vaginal herpes
- providing contact drainage
- taking secretion precautions
- third-trimester therapy for mother acyclovir 400 mg 3 times per day
what are symptoms of encephalitis?
- severe headache
- nausea/vomiting
- stiff neck
- fever
- dizziness
- ataxia
- convulsions/seizures
- sensory disturbances
- drowsiness
- coma
how can herpes encephalitis be diagnosed?
- CT scan and MRI
- EEG
- lumbar puncture, culture of CSF
- blood work
even if treated and not fatal, what is a serious outcome common in neonates who have had herpes encephalitis?
-permanent neurologic sequelae