Meninoencephalitis + LP stuff Flashcards
What are the physical exam tests for ?meningitis
Jolt accentuation test
Brudzinski’s sign
Kernig’s sign
What is a positive Brudzinski’s sign?
A positive Brudzinski sign
- passive flex the neck
- results in flexion of the hips and the knees of the patient
What is a positive Kernig’s sign?
Patient supine, bring knee up to 90 deg, extend leg at knee
- pos finding is resistance (or pain) with passive extension of the knee
- patient will resist leg extension or describe pain in the lower back or posterior thighs
Pathophys - resistance is thought to be due to meningeal inflammation in the setting of meningitis or other clinical entities that may irritate the meninges.
https://www.ncbi.nlm.nih.gov/books/NBK470365/
LP typical glucose levels in:
- bacterial
- viral
- fungal
bacterial and fungal infections, glucose is reduced
https://www.ncbi.nlm.nih.gov/books/NBK470365/
LP typical glucose levels in:
- bacterial
- viral
- fungal
bacterial and fungal infections, glucose is reduced
viral, glucose is normal
https://www.ncbi.nlm.nih.gov/books/NBK470365/
LP typical neutrophil vs lymphocytes in:
- bacterial
- viral
- fungal
Neutrophils are high in bacterial (1,000-10,000; >80%)
Lymphocytes are predominant in viral and fungal
https://www.ncbi.nlm.nih.gov/books/NBK470365/
Kernig, brudzinski, jolt accentuation tests specificity and sensitivity?
Kernig and Brudzinski
- specificities of 95%, sensitivity 5%
- considered highly predictive of bacterial meningitis when present in the appropriate clinical setting
Jolt accentuation
- sensitivity of 97%
Kernig, brudzinski, jolt accentuation tests specificity and sensitivity?
Kernig and Brudzinski
- specificities of 95%, sensitivity 5%
- considered highly predictive of bacterial meningitis when present in the appropriate clinical setting
Jolt accentuation
- sensitivity of 97%
https://www.ncbi.nlm.nih.gov/books/NBK470365/
What is the jolt accentuation maneuver?
- what presenting complaint is it most useful for?
- better for meningitis or encephalitis?
- how do you perform it?
- headache
- bedside maneuver to identify cases of meningitis
- rotation of the head horizontally two or three times per second
https://www.ncbi.nlm.nih.gov/books/NBK470365/
Classic triad of meningitis?
Present in what % of patients?
Fever, neck stiffness, altered mental status
- <50% of adult patients who are diagnosed with bacterial meningitis
What are the 2 most common pathogens causing acute bacterial meningitis?
Strep pneumo - Streptococcus pneumoniae
Neisseria meningitidis - “meningococcal meningitis”
What is the most treatable cause of encephalitis?
ie. which virus?
herpes simplex virus (HSV)
Complaints in patient with early meningitis? (4)
Late/severe findings? (2)
early/mild: headache, fever, n/v, neck pain
late/severe: confusion/altered mental status, or seizure
Symptoms (3) and exam findings (2) of meningitis in infants?
irritability, lethargy, poor feeding
rash, bulging fontanelle
Altered mental status and focal neurologic findings in a patient with suspected CNS infection raises concerns for meningitis or encephalitis?
encephalitis
What physical exam findings are “classic” for meningococcal meningitis?
Bonus: what bacteria causes “meningococcal meningitis”?
Petechiae and purpura
Neisseria meningitidis
Patient comes in with fever and altered mental status, you suspect meningoencephalitis, you want to do an LP. What do you need to do first?
CT scan of the brain before LP, ruling out signs of increased ICP so you don’t cause herniation of brain stem
LP typical protein in:
- bacterial
- viral
- fungal
- bacterial and fungal infections, protein is elevated
- viral, protein is normal
