neuro infections

Question 1

meningitis

Answer 1

acute inflam of meningeal tissues of brain and spinal cord

Question 2

meningitis: etiology

Answer 2

infection (lung or blood) or penetrating wounds
streptococcus pneumonia and Neisseria miningitidis (bacteria)
enteroviruses, parasites, toxins

Question 3

meninges

Answer 3

3 layers that protect brain and spinal cord
pia, arachnoid (CSF), dura (in -> out)
meningitis mostly in pia and subarachnoid, ventricular, CSF

Question 4

meningitis: patho

Answer 4

droplet: contaminated saliva
inhaled, attach to epithelial cells in nasopharynx, cross mucosal barrier into blood -> brain
infection of arachnoid mater and CSF, inflam response (neutrophils) and pus secretion (exudate thickens and impairs CSF flow), increase in CSF production, increase in ICP (closed system, no room)

Question 5

meningitis: rf

Answer 5

fall or winter (inside often), follows otitis or sinusitis, immunocomp, pna
age: >40 but also college -> large groups (prisoners, military, etc)

Question 6

meningitis: vax

Answer 6

11-12 yo, booster at 16, another in immunocomp or no spleen

Question 7

meningitis: cm triad

Answer 7

fever (d/t infection), HA (throbbing, meningeal irritation), stiff neck (nuchal rigidity, chin to chest stretches meninges)
maybe change in mental status

Question 8

meningitis: other cm

Answer 8

n/v, photophobia (bright lights), altered mental status (drowsy, seizure, d/t increased ICP, decreased LOC), meningococcus (skin rash - purpuric and mucus membranes, petechiae)
+ kering sign
+ brudzinski sign
both of above cause meningeal stretch

Question 9

kering sign

Answer 9

resistance to leg extension
1 leg extended, other flexed at 90 degrees, straighten flexed

Question 10

brudzinski sign

Answer 10

neck flexion causes hip/knee flexion
supine, flex neck, hip + knee will flex

Question 11

meningitis: bacterial

Answer 11

more common, high fatality if tm not started quickly (w/n hrs die, abx asap), petechial rash (not blanchable, septic microemboli)
long term: hearing loss, seizure, brain damage

Question 12

meningitis: viral

Answer 12

milder, typically no long term effects, usually no increased wbc

Question 13

meningitis: bacterial tm

Answer 13

aggressive abx: IV, usually multiple drugs (ceftriaxone, vancomycin -MRSA, acyclovir - prevent herpetic encephalitis, d/c if not needed after CSF results return)
steroid to decrease inflam
vax prophyl: meningococcus, pneumococcus, H. influenzae

Question 14

encephalitis

Answer 14

acute inflam of brain
viral: west nile, measles, chicken pox, mumps, HSV1 - herpetic, v severe and rapid

Question 15

encephalitis: cm

Answer 15

2-3 days, range from mild mental change to coma, vary based on location
fever, HA, n/v, other CNS changes (seizure)

Question 16

encephalitis: pharm

Answer 16

acyclovir (HSV1), decreased mortality but not neuro complications, supportive tm
seizure disorders: antiseizure meds (also meningitis)

Question 17

brain abscess

Answer 17

accumulation of pus within the brain tissue

Question 18

brain abscess: etiology

Answer 18

local (like encephalitis) or systemic infection
mostly ear, tooth, mastoid, sinus infection -> proximity
strep or staph

Question 19

brain abscess: cm

Answer 19

similar to meningitis and encephalitis: HA, fever, n/v
s/s increased ICP: drowsiness, confusion, seizure
focal s may reflect area of abscess: temporal = visual