meningitis/encephalitis clin

Question 1

clinical presentation of bacterial meningitis

Answer 1

progress v quickly to become serious

potential complications: hearing loss, memory difficulty, learning disabilities, brain damage, gait problems, seizures, kidney failure, shock, death

Question 2

most common cause of bacterial meningitis

Answer 2

strep pneumoniae

Question 3

____ used to be most common cause of bacterial meningitis children, no longer so bc of vaccines

Answer 3

H. influenzae

Question 4

cause of bac meningitis associated w teens and YA

Answer 4

N. meningitidis

Question 5

cause of bac meningitis associated w elderly

Answer 5

listeria monocytogenes

Question 6

clinical presentation of viral meningitis, most common causes

Answer 6

usually benign

enterovirus (polio), HSV, HIV, West Nile

Question 7

clinical presentation of fungal meningitis, most common organism

Answer 7

smoldering over months to years

cryptococcal- esp in DM and immunocomp

Question 8

parasitic, inflammatory, drug causes of meningitis

Answer 8

tosoplasmosis

sarcoid

Lamotrigine, IVIg

Question 9

signs and sx of meningitis in pts…

• > 2 yo
• newborns

Answer 9

• > 2 yo = sudden high fever, stiff neck, severe HA, confusion/diff concentrating, seizures, diff walking, photophobia, x appetite, skin rash (meningococcal meningtis)
• newborns= high fever, constant crying, sleepy/irratble, sliuggish, poor feeding, bulge in fontanelle, stiff body+neck

Question 10

trx for meningitis in pts < 1month old

Answer 10

ampicillin + cefotoxamine/aminoglycoside

Question 11

trx for meningitis in pts 1-50 yo or w basilar skull frx

Answer 11

vancomycin + 3rd gen cephalosporin

Question 12

trx for meningitis in pts >50 yo

Answer 12

vancomycin + ampicillin + 3rd gen cephalosporin

Question 13

trx for meningitis in pts w penetrating head trauma/postneurosurgery/CSF shot

Answer 13

vancomycin + cefepime/ceftazidime/meropenem

Question 14

clinical presentation of NMDA encephalitis

Answer 14

AUTOIMMUNE ENCEPHALITIS ASSOCIATED W SEIZURES + EPILEPSY, rapidly progress

young/middle aged woman
rapid onset (within 3 months)
commonly associated w teratoma

many will improve with aggressive treatmnwnt, but it may take a long time (~ i year)

Question 15

sx and labs of NMDA encephalitis

Answer 15

at least 4 of:
abn psych/cogn. function
speech dysfunction
seizures
decreased conscioussness
autonomic dys/central hypoventilation

at least 1:
abn EEG (rate, epileptic activity, extreme delta brush)
CSF w pleocytosis or oligoclonal bands
NMDA receptor Abs

Question 16

clin presentation of LGI1 encephalitis

Answer 16

AUTOIMMUNE ENCEPHALITIS ASSOCIATED W SEIZURES + EPILEPSY, rapidly progress

more commonly in men
don’t respond well to antiepileptic drugs, often require immunotherapy in conjunction

failure to identify–> permanent damage, long term cogn dysfunction, including short term memory
up to 1/3 will relapse

Question 17

sx of LGI1 encephalitis

Answer 17

faciobrachial seizures
(brief, of unilateral side of face and ipsi arm,
very frequent, up to hundreds a day

sleep disturbaces (50% pts)
acute hippocampal abn