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CMT > Meningitis & Encephalitis > Flashcards

Meningitis & Encephalitis Flashcards

1
Q

Meningitis

inflammation of which spaces

A
  • pia mater
  • arachnoid
  • CSF filled subarachnoid space
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2
Q

Meningitis

which age has majority of cases? why?

A
  • adults
  • vaccination
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3
Q

Meningitis

common bacterial organisms causing meningitis

5

A
  1. strep pneumoniae
  2. neisseria meningitidis
  3. Group B strep
  4. H. flu
  5. Listeria
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4
Q

Meningitis

sx in Bacterial Meningitis

6

A
  • Fever
  • HA
  • Nuchal Rigidity
  • AMS (altered mental status, confusion, lethargy)
  • photophobia
  • n/v
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5
Q

Meningitis

PE Findings

7

A
  • Fever
  • pos Kernig and Brudzinski
  • Nuchal Rigidity
  • Seizures
  • Focal Neuro Deficits (CN VI, III, IV, VIII)
  • Papilledema (rare)
  • skin rashes
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6
Q

Meningitis

describe Kernig Sign

A
  • flexing knee causes pain
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7
Q

Meningitis

describe Brudzinski sign

A

lifting head causes knee flexion w/ pain

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8
Q

Meningitis

describe CN III palsy

A

lateral, downward deviation
w/ ptosis

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9
Q

Meningitis

describe CN IV Palsy

A

upward deviation

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10
Q

Meningitis

CN VI palsy

A

medial deviation

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11
Q

Meningitis

essentials of dx

5 components

A
  1. fever, HA, v, delirium, seizures
  2. rash on skin/mucous membranes
  3. neck/back stiffness
  4. pos Kernig, Brudzinski
  5. purulent spinal fluid
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12
Q

Meningitis

dx

A
  • Head CT before LP
  • culture of cerebrospinal fluid
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13
Q

Meningitis

bacterial vs viral meningitis

A

bacterial more probable if:
* glucose < 34
* protein > 220
* WBC > 2000
* Neutrophil > 1180

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14
Q

Meningitis

what would gram positive diplococci in CSF suggest?

A

pneumococcal

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15
Q

Meningitis

what would gram negative diplococci in CSF suggest?

A

meningococceal

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16
Q

Meningitis

what would gram negative coccobacilli in CSF suggest?

A

H. flu

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17
Q

Meningitis

what do gram pos rods suggest?

A

listeria

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18
Q

Meningitis

what do gram pos cocci in pairs and short chains in CSF suggest?

19
Q

Meningitis

Labs for Dx bacterial meningitis

7

A
  • CMP
  • CBC
  • PT/PTT
  • Lactic Acid
  • STI Panel (HIV/Syphilis included)
  • Blood Cultures
  • UA
20
Q

Meningitis

imaging to dx bacterial meningitis

21
Q

Meningitis

Bacterial Meningitis Tx

A
  • emperic: cephalosporin w/ vanco
  • steroids: dexamethasone
  • ceftriaxone to clear NP carrying
22
Q

Meningitis

what to add to tx if suspecting…
* listeria
* HSV
* Rocky Mountain Spotted Fever

A
  • ampicillin
  • acyclovir
  • doxy
23
Q

Meningitis

describe aseptic meningitis

A
  • clinical and lab evidence for meningeal inflammation w/ mononuclear pleocytosis w/ negative gram stain, neg bacterial cultures
24
Q

Meningitis

causes of aseptic meningitis

6

A
  • viral
  • bacterial
  • fungal
  • medications
  • malignancies
  • autoimmunity
25
# Meningitis what is viral meningitis likely caused by? | 7
1. enterovirus 2. HSV 3. HIV 4. WNV 5. VZV 6. Mumps 7. CMV
26
# Meningitis describe enterovirus meningitis | 3 components
* most common cause * rash, sore throat, diarrhea, joint ache, HA * CSF: PMNs predominate early, repeat LP will show evolution to lymphocytic predominance
27
# Meningitis describe HSV meningitis | 4 components
* high CSF RBC count * HA, photophobia, stiff neck, neurologic complications * Tx: acyclovir IV * high mortality rate
28
# Meningitis predisposing factors for cryptococcosis meningitis
* chemo * Hodgkin lymphoma * corticosteroid therapy * structural lung diseases * transplant recipients * TNF alpha inhibitor therapies * AIDS
29
# Meningitis sx of cryptococcosis meningitis
* HA * AMS * meningismus
30
# Meningitis cryptococcosis meningitis CSF findings
demonstration of capsular polysaccharide antigen or pos culture
31
# Meningitis non-infectious causes of asepctic meningitis | 4 categories
1. malignancies 2. systemic processes 3. inflammatory 4. drug hypersensitivity
32
# Meningitis drug induced meningitis likely due to | 5
* NSAIDs * Abx * IV immune globulin * chemo drugs * anti-epileptics
33
# Meningitis pathophys
* delayed hypersensitivity rxn or direct meningeal irritation
34
# Meningitis PE findings Aseptic Meningitis | 5
* maculopapular exanthem (HIV/Syph) * parotitis (mumps) * vesicular and ulcerative gential lesions (HSV) * Oropharyngeal thrush/cervical LAD (HIV) * asymmetric flaccid paralysis (WNV)
35
# Meningitis aseptic meningitis CSF findings
* high lymphocytes * high protein * normal glucose, neg gram stain
36
# Meningitis prevention
* vaccination * PEP
37
differentiate encephalitis vs meningitis
* **Encephalitis**: abnormalities in brain function, AMS, motor/sensory deficits, altered behavioral/personality changes, speech, movement disorders * **Meningitis**: uncomfortable, lethargic, distracted by HA, cerebral function remains normal
38
# Encephalitis etiology (viral) | 9
* HSV * VZV * EBV * measles * mumps * rubella * rabies * CMV * arboviruses
39
# Encephalitis presentation
* viral prodrome (fever, malaise, myalgia, HA, etc) * signs/sx of causative agent * AMS from subtle deficits to complete unresponsiveness * seizures common * papilledema rare * focal neurologic abnormalities (hemiparesis, aphasia, CN palsies)
40
# Encephalitis imaging
* MRI sensitive for demyelination, edema, necrosis, inflammation * Head CT w/ or w/out contrast if suspecting space occupying lesions, brain abscesses
41
# Encephalitis what does temporal lobe involvement suggest
HSV encephalitis
42
# Encephalitis LP findings | 6
* PCR pos for viral cause * RBCs suggest HSV-1 * normal glucose * increased WBCs * elevated protein * elevated opening pressure
43
# Encephalitis Tx
* causative agent rarely identified, but tx of underlying cause if found * important to r/o HSV (if suspected, ASAP acyclovir) * corticosteroids

CMT (78 decks)

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