NEURO 1 Flashcards
causes of meningitis in 0-3m children 10-21 12> elderly
0-3m GBS commonest, listeria, E Coli children HI, strep pneumonia, niess mening 10-21 meningoococcal 21> pneumonocccal elderly pneumo, listeria, mening
kernigs
lie flat on the back, flex the thigh so that it is at a right angle to the trunk, and completely extend the leg at the knee joint. If the leg cannot be extended due to pain - POSITIVE
brudzinski
Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.
partially treated meningitis
neg CSF culture
glucose, protein WCC remains unchanged
GP
IV/IM benzylpenicllin 1.2g OR cefataxime 2g IV/IM
empirical
IV ceftriaxone 2g BD and IV amox 2g QDS if > 55
dexa 10mg IV 15-20mins before first dose or with first dose of ABs and then 6 hourly for 4 hours
who is dexa given in
pneumococcal - stopped in all others
meningococca
IV ceftr 2g BD
PA chloramphenicol IV 25mg/kg QDS 5-7 days and stop dexa
pneumococcal
10 d of ceftr or 14d if not responding and dexa for 4d
penicillin/cephalosporin resistant
14d of ceftr and vancomycin and dexa 4d
listeria
21d of amox IV 2g 4 hourly
PA co trimoxazole IV 120mg/kg QDS and stop dexa
Post op
IV ceftiazimide 2g 8 hourly and IV fluclox and IV vanc
prophylaxis for meningo rifampicin dose
600mg PO 12hourly 4 doses in >12
10mg/kg PO 12 hourly 4 doses in 3-11months
proph for meningo cipro
500mg PO single dose
proph ceftriaxone
250mg IM in adults single dose
125 mg IV single dose in <12s
which proph is preferred
ciprofloxacin
complications of meningitis
deafness is the commonest
epilepsy
infection - sepsis, abscess
pressure - brain herniation, hydrocephalus
CSF of bacteria
high opening pressure cloudy colour increased WCC >2000 - polymorphs neutrophils glucose low <40% increased protein
CSF of viral
normal or increased pressure gin clear colour 5-1000 WCC lymphocytes normal glucose protein slightly raised
CSF of TB
high pressure cloudy yellow colour <500 WCC lymphocytes glucose low raised protein - can be higher than bacteria
CSF of fungal
high/v high opening pressure clear/cloudy colour 0-1000 WCC lymphocytes normal/low glucose protein level variable
viral meningitis cause
who
and treatment
ECHO
older, young, immunocomp
self limiting, analgesia
aseptic meaning what is it
who
CSF
non pyogenic bacterial mening
HIV. viral mening
low WBC, minimally elevated protein, normal glucose
treatment of viral encephalitis if immunocomp or 2m-12yo
if normal
21d aciclovir
14d
aiclovir doses neonates-3m
3m-12yo
>12yo
20mg/kg
500mg/m swquared
10mg/kg
ADJUST FOR RENAL FAILURE
cerebral abscess ix
CT/MRI contract enhanced
if d in doubt stereotaxic biopsy
increased WCC increased ESR/CRP coag if surgery
rx of cerebral abscess
IV ceftriaxone 2g QDS and IV metro 500mg 8 hourly
Add Iv fluclox 2g QDS if staph infection suspected
IV vanc if PA/MRSA surgery - decompression
