Neuro Flashcards
List bacterial causes of meningitis in neonates.
- Group B strep (3/4) o Early GBS infection reduced with pre-partum prophylaxis o Late (>7 days not prevented by intrapartum antibiotics) - E coli - Neisseria menigitidis - Staph epidermidis - Staph aureus - Group D strep - Ureaplasm urealyticum - Heamophilus type b - Non typeable Haemophilus - Listeria monocytogenes – common in certain immigrant groups, assoc with unpasteruised milk
Beyond the neonatal period, what are the main causes of ABM?
- Strep pneumo 45%
- N. meningititis 45%
- H. flu
- Less common (
List host factors that increase the risk of meningitis.
- Age
What are the basic four steps in the usual development of meningitis and encephalitis?
- Infection of respiratory tract
- Development of bacteremia
- Invasion of the meninges
- Inflammation of the brain
List additional means by which bacteria gain access to the meninges and CSF.
- Mechanical disruption o VP shunt o Basal skull fracture o LP - Direct extension o Sinusitis o Mastoiditis o Otitis media
List indications for LP in meningitis (Box 175-1)
- Signs and Sx of meningitis or toxic appearance
- Febrile infants
What is the normal CSF serum glucose ratio, what is hypoglucorrhachia?
What is a normal CSF protein?
- Normal: ~0.6 to 1.0
- Hypoglucorrachia:
Who is at a very low risk of bacterial meningitis in patients with CSF pleocytosis?
- Patients with CSF pleiocytosis have a very low likelihood of ABM if they have none of the following: o +ve Gram stain o CSF ANC > 1000 o Peripheral ANC > 10,000 o Protein >.8 g/L o Hx seizure before or at presentation
Who should get a CT head before LP?
Focal neuro signs
- Signs elevated ICP – ie papilledema
- Seizure
- Known intracranial mass
- Hx head trauma
- Immunocomprimised
List risks of dexamethasone in bacterial meningitis.
- GI bleeding
- False sense of clinical improvement
- Reduced blood brain barrier penetration of vancomycin (although this has not been shown to reduce the time to sterilization of the CSF)
List indications for empiric acyclovir in menigoencephalitis.
- Ill or febrile infant with a history of maternal HSV infection
- Vesicle on the skin
- Seizure
- Focal neuralgic findings
- Atypical presentation of sepsis or meningitis
Describe infantile spasms.
- Onset in the first year of life, rapid, jackknife flexor or extensor spasms that appear in clusters
- 2/3 associated with a congenital brain malformation or tuberous sclerosis
- Majority will progress and become significantly developmentally delayed.
What is the triad of West syndrome?
- Infantile spasms
- Arrested psychomotor development
- Hypsarrythmia (characteristic EEG pattern)
Describe Benign Rolandic Epilepsy of Childhood.
- Partial epilepsy between ages 3 and 13 years
Seizures occur while sleeping involving the face and twisting of the face mouth and anarthria
What is the defininition of a febrile seizure, and what age group does it affect?
- Def:
o Seizure accompanied by a fever without CNS infection
o 6mo – 5 years old
o Developmentally normal child - At risk during rapid rise in fever, typically early in the course of an illness
- Slight increase in risk of epilepsy from 1% (baseline population) to 2% with febrile Sz.
