Meningitis Management Flashcards
What is the classic triad of symptoms in bacterial meningitis?
Fever, neck stiffness, altered mental state
This triad is only seen in 44% of adults with bacterial meningitis and even fewer children.
List the symptoms of meningism.
- Headache
- Photophobia
- Nuchal rigidity
Nuchal rigidity refers to neck stiffness.
What are signs of raised intracranial pressure (ICP)?
- Altered GCS
- Papilloedema
- Cushing triad
- Nerve palsies
Cushing triad:
- Bradycardia
- Bypertension with widening pulse pressure
- Cheyne-Stokes respirations (abnormal breathing pattern characterized by periods of hyperventilation followed by periods of apnea)
What is Cushing triad?
- Bradycardia
- Hypertension with widening pulse pressure
- Irregular Cheyne-Stokes respirations (abnormal breathing pattern characterized by periods of hyperventilation followed by periods of apnea)
These are signs indicating raised ICP.
What are the signs of transtenorial/uncal herniation?
- Ipsilateral CN III palsy (dilated pupil)
- Contralateral hemiparesis
These signs indicate severe complications of raised ICP.
What are the signs of increased intracranial pressure in infants?
- Tense anterior fontanelle
- Setting sun sign
- Macrocephaly
These signs are critical in diagnosing meningitis in infants.
What blood tests are performed in suspected meningitis?
- FBC
- CRP
- U&E
- C&S
- Glucose
- Coag
- VBG
VBG may show raised lactate in sepsis.
What is the purpose of a lumbar puncture (LP) in meningitis diagnosis?
Definitive diagnosis after CT head to check for contraindications
CSF analysis includes glucose, protein, microscopy, culture, lactate, and PCR for various pathogens.
What are contraindications to lumbar puncture?
- Local skin infection
- Bleeding diathesis
- Signs of spinal cord compression
- Papilloedema
- Suspicion of intracranial or cord mass
- Congenital neurological lesions
These conditions increase the risk of complications from the procedure.
What is the empirical antimicrobial treatment for meningitis?
- Cefotaxime/ceftriaxone + vancomycin
- Add ampicillin if risk of listeriosis
- Add aciclovir if HSV not excluded
Chloramphenicol is used for penicillin or cephalosporin hypersensitivity.
When should steroids be administered in meningitis treatment?
Before or with the first dose of antimicrobials
IV dexamethasone reduces risk of neurological sequelae
What are the conditions under which steroids should be withheld in meningitis treatment?
- Septic shock
- Meningococcal septicaemia
- Immunocompromised patients
- Meningitis following surgery
These conditions may complicate treatment and worsen outcomes.
