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clin med > neuro- CNS infections > Flashcards

neuro- CNS infections Flashcards

1
Q

types of CNS infections- 4

A

meningitis
encephalitis
space-occupying infection lesion
prion disease

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2
Q

3 large groups of meningitis

A

acute bacterial (BAD!, go to ER!)
aseptic/viral/encephalitis
chronic

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3
Q

3 major risk factors for CNS infections

A

immunosuppressed, cranial trauma, pediatric pt

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4
Q

main types of meningitis

A

bacterial (emergency) , viral, fungal or mycobacterium TB (chronic)

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5
Q

what is the percentage mortality for S pneumoniae and gram neg. organism meningitis?

A

36%

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6
Q

bacterial meningitis epidemiology: the ___ of the pt often suggests the likely etiologic organism

A 
age
1month - 4y : HIB
4-30 : meningococcal men. 
30+: S. pneumoniae 
* infants-30yo get bacterial meningitis more than older people
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7
Q

____ is an antibiotic for prophylaxis for those who have been exposed to meningitis

A

rifampin

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8
Q

bacterial meningitis transmission

A

exposure: birth canal, other routes
colonization: nasopharynx (respiratory)
BBBBBB: Bad Bug Breaches Blood Brain Barrier : organism that invades meninges, subarachnoid, CSF

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9
Q

clinical diagnosis of bacterial meningitis includes: S&S and “signs” , progression?

A

fever, HA, stiff neck, petechial rash w/ meningococcus (non-blanchable)

  • nuchal rigidity (stiff neck)
  • budzinski (move neck and legs bend) and kernig’s signs (lift leg, cant straighten, pain)
  • progression - quickly worsen
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10
Q

what procedure would you do to clinically diagnose bact. meningitis?

A

LP for CSF abnormalities
-CT scan head before ONLY if they have one of the following risk factors (immunocompromised, CNS disease, new seizure, papilledema, LOC off, focal neuro deficit)
…otherwise do it right away

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11
Q

if clinical exam does not suggest ____, do LP w/out CT, why?

A

elevated ICP

one hour with bact. meningitis is BAD

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12
Q

if exam reveals uncertainty about presence of elevated ICP… follow these 5 steps

A
  1. draw blood for C&S
  2. start IC steroid/abx
  3. CT
  4. no elevated ICP ? LP!
  5. cell count, gram stain, C&S of CSF
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13
Q

meningitis CSF will look…with what predominating in it? opening pressure will be…

A

cloudy or grossly purulent

  • PMN predominating (neutrophils)
  • opening pressure is elevated! (normal is about 18cm, meningitis is 30-40 )
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14
Q

what abx and why steroids with them for meningitis?

A

bacteriocidal to kill

steroids to deal with immune/inflamm response from taking the bacteriocidal

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15
Q

viral meningitis lab- what is the go-to?

A

PCR of virus from CSF - very sensitive

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16
Q

how to distinguish encephalitis/viral men. from bacterial menin. ?

A

encephalitis- level of consciousness changes and neurological signs
-virus can penetrate tissues where bacteria cant

17
Q

bacterial vs viral meningitis, WBC and lymph cell counts?

A

bacterial- WBC high

viral- WBC low, lymphs high

18
Q

rabies encephalitis: how can you get it? incubation period?

A

serious viral encephalitis from salivary transmission of infected animal but recent cases show “casual contact” routes of infection

incubation: 10 days to 1 year
- death certain if untreated and symptomatic

19
Q

txt for rabies encephalitis

A

rabies immunoglobis and rabies vaccine of exposed individuals
-amount of immunoglobin depends on pt’s body weight

20
Q

west nile virus: what is it? what can it cause? symptoms? txt?

A

mosquito-born significant viral encephalitis

  • possible permanent neuro damage
  • most are asymmptomatic , flu symptoms in summer = west nile
  • txt is supportive
21
Q

chronic meningitis from fungal or mycobacterium/TB - CSF findings…?

A

vague, look like viral

22
Q

chronic meningitis S &S

A

evolves over a long time

  • meningeal signs (more subtle)
  • cranial nerve palsys (brain expanding)
  • CSF rhinorrhea
  • chronic infection –> arachnoid fibrosis (can’t reabs. CSF), hydrocephalus, brain infarction
  • often fatal
23
Q

txt for chronic meningitis?

A

culture to diagnose

  • multiple drugs for TB
  • syst. antifungals
  • debridement of sinuses (if it came from there)
24
Q

3 space occupying lesions in the CNS

A
  • cycticerosis
  • toxoplasmosis
  • abscesses
  • symptoms common w/ tumors –> HA, seizure, LOC
25
Q

cysticerosis: how do you get it?

A

caused by larva of pork tapeworm, get by eating eggs not the larvae (if you ate the larvae you would just get a tapeworm).

  • assoc. with dirt eating “pica”
  • poor hand washing
  • contaminated water
26
Q

txt of cysticerosis

A

treat only acute CNS- w/ symptoms- self-limiting, will not spread or worsen as the eggs die

  • antihelminthic may inc symptoms b/c of inc inflamm when the larvae die –> need to treat with steroids as well
  • seizure meds if anatomic defect remains
  • drugs- albendazole or praziquantel
27
Q

toxoplasmosis: how can you get it?

A

caused by parasite- ingesting raw beef , oral-fecal or to fetus in third trimester

28
Q

4 types of toxoplasmosis infection - where can you get it?

A

asymptomatic infection
CNS (space-occupying lesion)
respiratory
ocular

29
Q

Dx of toxoplasmosis

A

serology IgM and IgG may be detected in CSF and serum

MRI- shows ring-enhancing lesions in brain

30
Q

txt of toxoplasmosis

A
  • trimethoprim/sulfamethoxazole (septra/bactrim)

- longterm prophylaxis for immunosuppressed pts

31
Q

brain abscess - why is this worse than other parts of the body?

A

not much immune function in the brain

32
Q

brain abscess epidemiology

A

rare disease

in 2-30% of toxoplasmosis infection in AIDs patients

33
Q

patho of brain abscess

A

starts in outside CNS and spreads into CNS
or direct inoculation
-look for a source: ear, lung, sinus

34
Q

S&S of brain abscess

A

fever, drowsy, HA, focal neuro deficits, seizures

-most have symptoms for 2 weeks or less

35
Q

BA workup

A

CBC
CT/MRI (localize and determine capsule size- shows ring-enhancing lesion)
aspiration of biopsy abscess
*LP is contraindicated

36
Q

txt BA

A

surgical drainage,
abx
intrathecal (into spinal canal) admin of drugs
txt underlying infection cause

37
Q

what is the mortality rate for a BA?

A

40-60%

38
Q

prions

A

“protein-infectious cause”

  • i.e. mad cow- get by eating infected tissue
  • kuru- cannibalism
  • progressive encephalitis
39
Q

txt and prognosis for prions?

A

no txt, bad prognosis

clin med (88 decks)

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