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
