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Hailey - Neuro > Meningitis/Encephalitis > Flashcards

Meningitis/Encephalitis Flashcards

1
Q

listeria mortality rate

A

25%

gram + rod (positive purple listeria)

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2
Q

listeria empiric Tx

definitive Tx

A

ceftrixone and ampicillin

definitive: ampicillin and gentamicin
Gentlemen get amped up on Listerine.

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3
Q

most common cause VIRAL M&E in summer/fall

A

enterovirus

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4
Q

cell wall inhibitors mech (general)

A

inhibit transpeptidation of peptidoglycan (inhibit cell wall* synthesis)

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5
Q

Listeria monocytogenes
gram ___
big 3 and ___
virulence

A

gram + rod (purple positive listerine)
big 3 and nuchal rigidity and diarrhea from soft cheese, deli, etc.

internalin induces phagocytosis
phospholipase and listeriolysin O allow escape
actin tail

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6
Q

if focal mass lesion, labs

A

no LP – increased risk of brain herniation = BAD

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7
Q

risks with 3rd generation cephalosporin: ceftriaxone

A

increased risk of neurotoxic side effects

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8
Q

Why treat empirically with ceftriaxone?

A 
bactericidal
small 
lipophilic
can cross BBB
not a ligand for efflux pumps
streptococci +
serious gram -
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9
Q

most aggressive empiric treatment combo

A

ceftriaxone
vancomycin
acyclovir
dexamethasone

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10
Q

encephalitis vs encephalopathy

A

encephalitis: infection (fever, headache, focal neuro signals, seizures)
encephalopathy: diffuse cerebral dysfunction WITHOUT inflammation, usually due to toxin or metabolic dysfunction

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11
Q 
where's waldo: 
meningitis
encephalitis
abscess
myelitis
A

m: subarachnoid space
e: diffuse parenchyma
a: focal parenchyma
my: spinal cord

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12
Q

etiology of encephalitis

A 
33-66% unknown
then viral (entero, adeno, herpes, rabies)
also nonviral (ricketssia, mycoplamsa, ADEM)
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13
Q

STAT TO DO with CNS infection

A
  1. H and P*
  2. blood culture*
  3. start abx*
  4. neuroimaging*
  5. LP/biopsy
  6. ID organism (gram stain/PCR/RT-PCR)
  7. switch to definitive Tx
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14
Q

BM labs

A 
increased pressure
increased WBC
>80% PMNs
elevated protein
decreased glucose
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15
Q

VM labs

A 
mod WBC count
>50% Ls
<20% PMNs
mod protein
normal glucose
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16
Q

FM labs

A 
increased pressure
m100 WBC
>50% Lymphocytes
mod elevated prto
normal glucose
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17
Q

Aseptic meningitis

A

> 85% VIRAL: enterovirus/picornavirus, HSV2, arthropod, HIV
highest incidence within 12mo old

Sx: fever, HA, photophobia, dec nuchal rigidity, change mental status

CSF: increased Lymphocytes and PMNs, mod inc protein, normal glucose

Tx: supportive therapy
can be fatal in neonatal period

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18
Q

Septic meningitis

A

BACTERIAL: streptococcus pneumonia+ lancet (adults), neisseria meningitides - diplococci (teen/college), homophiles influenza type B - pleomorphic (babies, w/ no vaccine)

Sx: fever, nuchal rigidity, iritability, neuro dysfxn

CSF: inc PMNs, inc protein, dec glucose

LIFE THREATENING, PROMPT EMPIRIC TX
ceftriaxone, vanco (MRSA), acyclovir (HSV2), cefeprime (psuedomonas), ampicillin (listeria)

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19
Q

Chronic meningitis

A

SPIROCHETES - treponema pallidum/syphilis, borrelia burgdorfori
MYOCBACTERIUM TUBERCULOIS (india ink*)
FUNGI - cryptococcus neoformances, coccoides, candida albicans
IMMUNOCOMPROMISED

Tx: 4 drugs RIPE
Ri
Isoniazid
P
E
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20
Q

TORCH infections (perinatal)

A 
Toxoplasma
Other: syphilis, VZV, parvovirus B19, group B strep, e. coli
Rubella (german measles)
CMV cytomegalovirus
HSV-2/HIV
21
Q

HSV associated with

A

temporal lobe (would see on MRI)

22
Q

BM gross

A

PURULENT/PUS

particularly dense over engorged blood vessels

23
Q

VM gross

A

swollen, or look normal (no pus/exudate)

24
Q

BM micro

A

NEUTROPHILS inside vessels = phlebitis, into brain tissue = cerebrates
FIBRIN in exudate: healing stage in exudate > BAD = disrupts absorption of CSF > hydrocephalus

25
Q

VM micro

A

lymphocytic infilatrion, mild

mononuclear: round, dark cell

26
Q

mycobacterium tuberculosis

A 
more chronic fashion
acid fast
basal exudate that obliterates cisterns (interferes with cistern magnum and CNs)
exudate more GELATINOUS/CREAMY
ADHESIONS/STRINGY
MONONUCLEAR CELLS
GRANULOMAS: obliterative endarteritis
caseating
hisitocytes
27
Q

pathology of acute inflammation

A

neutrophils
vessels larger and leakeir
“busy”
mickey mouse nuclei

abscess: neutrophils stick around
circumscribed collection of pus, GREEN NEUTROPHIL EXUDATE

chronic: mononuclear cells, more uniform than “busy”

28
Q

gliosis

A

astryocyte rxn to injury

29
Q

migroglial cells

A

proliferate around single neuron dying off, around areas of necrosis

30
Q

hydrocephalus from meninigitis…how

A

if healing blocked ventricles = communicating = all vent sys involved

31
Q

CNS infections

A

Meningitis: Neiserria, strep pneu, h influ, fungal
Encephalitis: viral (herpes)
Abscess: strep, staph

32
Q

abscess

A 
mix of bacteria:
strep
pseudomonas
haemophilus
staph
bacteroides
33
Q

enterovirus

A

single stranded + sense RNA
capsid
no envelope

34
Q

transmission/development

A

muscosal colonization > invasion and multiplication in bloodstream > cross BBB > in CSF > release inflammatory cytokines in CSF by astrocytes and microglia > increased perm BBB > diapedesis of leukocytes > edema > inc ICP > HA > neuronal injury

35
Q

virulence factors

A 
capsule IMPT
IgA protease
Pili help attach to mucosa
endotoxin (by gram -)
outer membrane proteins
36
Q

Neisseria meningitides virulence special

A

LOS: looks like brain sphinoglipids, so is recognized as self
skin rash
transmitted through respiratory droplets

37
Q

H flu type B special because

A

B capsular polysaccharide help facilitate its invasion into the brain
CHOCOLATE AGAR

38
Q

Mycobacterium tuberculosis special because

A

ACID FAST bacilli stain

RIPE Tx

39
Q

RIPE Tx

A

Rifampin - inhibits dDNA RNA pol, inhibits cypP450
Isoniazid - inhibits mycolic acids
Ethambutol - inhibits cell wall synthesis by binding arabinysyl transferase
Pyrazinamide

40
Q

cryptococcus neoformans special because

A

INDIA INK STAIN
inhaled as spores, like yeast
in IC
fluconazole 4 lyfe

41
Q

site of herpes latency

A

NEURON

42
Q

herpes viruses are Baltimore class

A

Class I

ds DNA

43
Q

VZV most comomon cause of encephalitis among

A

IC patients

particularly if have HIV/AIDS or stem cell transplantation

44
Q

only alpha herpes virus produce

A

thymidine kinase

so can use acyclovir

45
Q

acyclovir

A

DNA polymerase chain inhibitor, stops new DNA made, dGTP switched out

46
Q

Tx betaherpesviruses

A

gancyclovir

47
Q

post-infectious encephalitis

A

ADEM acute disseminated encephalomyelitis MOST COMMON
inflammatory demyelinating condition, monophasic, pediatric usually, days to weeks post-inf

also
APME acute disseminated encephalomyelitis (demyelination, M and S defects)
SSPE subacute sclerosing panencepthalitis MOST SCARY

48
Q

measles virus

A

Class V, ssRNA -

enveloped

Hailey - Neuro (10 decks)

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