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Nayla Foundations Exam 4 > Meningitis/Encephalitis > Flashcards

Meningitis/Encephalitis Flashcards

1
Q

What are the ways an infection can reach the CNS

A

Invade the blood stream
Retrograde neuronal path
Direct contagious spread

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2
Q

What is encephalomeningitis

A

Inflammation of brain and spinal cord

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3
Q

What is encaphalitis

A

acute inflammation of the brain parenchyma causing abn function (AMS, sz, change in behavior or speech

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4
Q

What is the MCC of encephalitis

A

Virus (70%)

also bacteria and fungi

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5
Q

What is primary encephalitis

A

Virus is seen or cultured- (+) neuronal involvement

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6
Q

What is post infectious encephalitis

A

Virus is not present, there is demyelination- (-) neuronal involvement

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7
Q

Increased mortality occurs in patients who

A

have multiple comorbidities

extremes of ages

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8
Q

Who is high risk for viral encephalitis

A

traveling to endemic areas
Out doors
Not vaccinated
immunodeficient

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9
Q

What organisms are associated with viral encephalitis

A 
HSV
Arthropods (west nile, St. Louis) 
Rabies
HIV
Enterovirus
Measles
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10
Q

If bacterial, what can cause encephalitis

A 
B. burgdorferia
T. pallidum
Listeria
Strep 
Klebsiella
N. meningitidis
M. tuberculosis
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11
Q

Non-infectious causes of encephalitis are

A

Drugs
Autoimmune
Radiation
Paraneoplastic syndrome

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12
Q

How does encephalitis present

A

fever, *seizures, AMS, Focal neuro sx (paralysis, CN palsy, increased DTR)

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13
Q

What does encephalitis usually NOT present with

A

meningeal irritation (photophobia, nuchal rigidity)- unless it’s meningoencephalitis

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14
Q

What history points you in the direction of encephalitis

A 
recent travel (vectors) 
recent illness
season
outdoor activities
birth Hx HSV
Parotitis (mumps) 
hydrophobia (rabies)
zoster rash (HZV)
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15
Q

What will you see on Encephalitis PE

A

Papilledema
flaccid paralysis (WNV)
arthritis (lyme, SLE)
Diabetes insipidus, SIADH= no temp control
Retinitis (CMV, WNV, paraneoplastic syndrome)

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16
Q

What rashes are commonly found with encephalitis

A 
Vesicular eruption (HSV, VZV) 
Maculopapular rash (EBV) 
Malar rash (SLE) 
Petechial rash (meningococcus, rickettsia) 
Erythema migrans (lyme) 
Erythema nodosum (TB, histo, sarcoidosis) 
Erythema multiforme (HSV, EBV, Mycoplasma) 
Kaposi sarcoma (AIDS)
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17
Q

Describe rashes by location

A

mucus membrane= Herpes
Gumma= tertiary syphillis
Genital lesions= HSV

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18
Q

How do you diagnose Encephalitis

A

MRI > CT

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19
Q

Diagnostic pro-tip

A

start with CT w/con if pt is really sick (if high Cr, do non-con)
It is faster and you can r/o mass lesion
also must do this before LP can be done

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20
Q

What is a contraindication to LP

A

Mass lesion! (r/o with CT first)
Sx of increased ICP (papilledema, focal neuro Sx, decreased LOC)
Severe coagulopathy or on anticoags
Skin infection

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21
Q

What MRI findings indicate encephalitis

A

Herpes: temporal lobe
Post-infectious: demyelination present
+/- hypersensitivity in edematous areas

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22
Q

What should you analyze with LP

A

opening pressure
cell count (w/ diff), glucose, protein, culture, gram stain
PCR (HSV and enterovirus)
IgM (WNV)

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23
Q

What is Cushing’s Triad

A

Respiratory depression
Bradycardia
Hypertension

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24
Q

How do you preform an LP

A

Lying or sitting, in L3-L5
Draw 15-20 ml CSF (4 tubes) and send to lab FAST
Do not refrigerate (H influenza and N meningitidis will die)

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25
Q

How long does cellular degradation last

A

ONE HOUR (must send quickly to lab

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26
Q

LP steps are

A

Measure CSF pressure, then draw 4 tubes

chem serology- microbio- hematology- special study

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27
Q

What does normal CSF look like

A

clear like water

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28
Q

When does it become turbid

A

WBC >200
RBC >400
gross body fluids RBC >6000 (GROSSLY BLOODY)
bacteria/protein >150

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29
Q

What can cause leukocytosis in CSF

A

Bacterial meningitis
vasculitis
leukemic infiltrate
traumatic tap

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30
Q

What does pink/red CSF indicate

A

Traumatic tap (blood clear by tube 3
SAH (stays uniformely bloody)
ICH
cerebral infarct

31
Q

Viral Encephalitis CSF will look like this

A 
Cloudy/straw colored 
Normal-increased OP
Elevated white count
Lymphocytes on differential
0 RBC (unless HSV) 
normal-increased protein
normal glucose
32
Q

What are other diagnostic tests you can get for Viral Encephalitis

A 
CBC (eosinophilia, lymphocytosis) 
Peripheral bleed smear (malaria) 
Culture (bacterial? arbovirus?)
IgG, IgM Ab (WNV has IgM) 
Electrolytes (SIADH)
Sputum (TB)
CXR (infx vs non-infx) 
Whole body PET/CT (malignancy)
33
Q

What is the Gold Standard for viral encephalitis (but not really used)

A

Brain biopsy (it is invasive

34
Q

What is your goal with viral encephalitis

A

ID the cause, consult infectious disease and neuro ASAP

35
Q

How do you manage encephalitis

A

Stabilize (ET tbe, vent, circulatory support, electrolytes)
Start Empiric Antivirals
Treat offending agent
**Isolate until cause is identified!

36
Q

What can mimic a CNS infection

A

Tumor
Med S/E
AI
Increased ICP

37
Q

What do you want to prevent and manage with viral encephalitis

A

secondary bacterial infections
DVT
GI ulcers

38
Q

How do you manage increased ICP

A

elevate head of bed 30-45 degrees
Hyperventilate to PaCO2 30
+/- corticosteroids and Mannitol

39
Q

What is empiric treatment for Viral encephalitis

A

Acyclovir (HSV, VZV) early, and refine when cultures come back

40
Q

What is primary prevention for viral encephalitis

A 
Avoid vectors (bug spray) 
Vaccines (MMR, polio, rabies, meningitis)
41
Q

What is meningitis

A

inflammatory disease of leptomeninges around brain and spinal cord

42
Q

What are some meningitis RF

A 
Extremes of ages 
birth infection from mom
immune/vaccine status
exposure risk
IVDU
43
Q

What are meningitis symptoms

A 
HA
photophobia
N/V
fever
neck stiffness
44
Q

This means bacterial meningitis until proven otherwise

A

Headache + Fever

45
Q

If not fatal, what are common outcomes of bacterial meningitis

A

Neuro sequelae
brain damage
hearing loss
learning disability

46
Q

What is viral meningitis

A

Aseptic; meningeal inflammation WITHOUT bacterial infection
can be due to malignancy, fungal, or meds
Self-limited disease course

47
Q

What are symptoms of viral meningitis

A

All normal +/- URI sx, rash, diarrhea

48
Q

What is the MCC of viral meningitis

A

Enterovirus (coxsackie, herpangia, polio)

49
Q

What is HSV2 preceded by

A

genital lesions

50
Q

What does mumps meningitis present with

A

Headache
low grade fever
mild nuchal rigidity
Mumps parotitis

51
Q

What does viral meningitis CSF look like

A 
*Cloudy color 
normal-high pressure
Elevated WBC 
Lymphocytes on differential 
0 RBC
*Elevated protein 
normal glucose 
(* are the only differences from viral encephalitis)
52
Q

How does bacterial meningitis occur in adults

A

Hematogenous spread of bacteria
adjacent infected structures
penetrating injury

53
Q

How does bacterial meningitis spread in neonates

A

Pathogens from birth canal**

also placenta or surroundings

54
Q

What happens after the bacteria is acquired

A 
Multiplies quickly (patients present w.in 24 hours) 
Bacteria in CSF cause inflammatory cascade--> cerebral edema and high ICP--> neuro damage and possibly death
55
Q

What happens if bacterial meningitis is not treated

A

DEATH!!

This is an EMERGENCY

56
Q

What are the causes of bacterial meningitis by age

A

Neonate: Group B Strep (agalactiae)
Baby/child: Strep pneumo
Teen: N. Meningitidis
Adult: Strep Pneumo

57
Q

When do pregnant women get tested for group B strep

A

35-37 weeks gestation

If (+), they get prophylactic abx during labor to protect baby

58
Q

What are general bacterial meningitis symptoms

A

slow or rapid onset fever, meningismus, +/- AMS, severe HA, N/V, photophobia, back pain
Neonates also: Irritable, poor feeding, floppy, high pitch cry, vomiting, lethargy

59
Q

What are red flags in the history

A 
Travel
birth Hx
recent infx
vaccine
exposure
Hx drug allergies, recent abx
60
Q

What do bacterial meningitis vitals show

A

Hypotension
tachycardia
tachypnea
+/- fever, low O2, wide pulse pressure

61
Q

What are skin Sx of bacterial meningitis

A

Non-blanching petechiae/purpura rash

Cold/clammy (shock)

62
Q

What are some HEENT findings in bacterial meningitis

A

bulging fontanelles and head circumference

papilledema

63
Q

What are some neuro findings in bacterial meningitis

A

Irritability

Kernigs and Brudzinski’s

64
Q

How do you manage bacterial meningitis

A 
IV access (fluids) 
Cultures (2 diff sites at 2 diff times) 
Start Abx 
CBC w/ diff, CMP, coags
\+/- CT or LP (dont delay abx to do these if susp. bacterial meningitis)
65
Q

What does strep pneumo antigen test detect

A

Presence of C polysaccharide cell wall antigen

66
Q

What does bacterial meningitis CSF look like

A 
Turbid yellow color
Increased OP
VERY elevated WBC
Neutrophils on differential 
0 RBC
Very elevated protein
Low glucose 
(bacteria eat the glucose and poop the protein)
67
Q

What is emperic treatment for bacterial meningitis

A

Ceftriaxone/Cefotaxime (3 gen ceph) + Vancomycin

Also add Ampicillin if 50+

68
Q

What is emperic Tx for bacterial meningitis if allergic to penicillin

A

Moxifloxacin + Vancomycin

If 50+ add Bactrim

69
Q

What is supportive treatment for bacterial meningitis

A

Fluid management
ICP control (hyperventilate, elevate bed, +/- glucocorticoid dexamethosone)
+/- induced hypothermia

70
Q

What bacteria yields the worse prognosis

A

N. Meningitidis (teens)

71
Q

What are common neuro complications with bacterial meningitis

A 
AMS
increased ICP/edema
Sz
focal neuro deficit 
hearing loss
72
Q

Who should have meningitis prophylaxis

A

> 8 hours contact at closer than 3 feet

Direct exposure to oral secretions 7 days before Sx or 24 hours after Tx

73
Q

How can you prevent bacterial meningitis

A

Vaccination against;

  • serogroup A, C, W, Y: Menactra 9 mo- 55 y/o OR Menveo 2 mo. to 55 y/o
  • Serogroup B: Trumenba 10-25 y/o OR Bexsero 10-25 y/o
74
Q

When is meningococcal B (MenB) vaccine given

A

10+ with persistent asplenia
working with N. Meningitidis
High risk

Nayla Foundations Exam 4 (15 decks)

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