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Neuro II > Non-viral infections of the CNS > Flashcards

Non-viral infections of the CNS Flashcards

1
Q

What are the mechanism of CNS infection?

A
  • Direct seeding
    • foreign objects, operative procedures
  • hematogenous spread
    • nasopharynx, bloodstream, subarachnoid space, corsses BBB
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2
Q

What are the major sources of infection that lead to CNS infection?

A
  • skull fracture
  • otitis media/mastoiditis/sinusitis
  • pneumonia
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3
Q

Which etiological causes of bacterial meningitis have the highest rate of mortality?

A
  • S. pneumonia (19-26%)
  • H. influenzae (3-13%)
  • N. meningitides (3-13%)
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4
Q

What complications can arise from bacterial meningitis?

A

hearing loss, memory difficulty, learning disabilities, brain damage, gait problms, seizures, kidney failure, shock

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5
Q

What are the most common cuases of bacterial meningitis?

A
  • S. pneumoniae
    • a/w pneumonia or ear/sinus infection
  • N. meningitidis
    • a/w URI
    • highly contagious
  • H. influenzae
    • resp spread
    • a/w pneumonia - cellulitis, epiglotitis, arthritis
  • Listeria monocytogenes
    • unpasteurized cheases, hot dogs, lunchmeats
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6
Q

What history is especially important to gather if you suspect a patient has bacterial meningitis?

A
  • recent illness/sick contacts
  • immunizations
  • contact w/ animals or insects
  • immunocompromised
  • recent travel; geographical location
  • trauma
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7
Q

What is the classic meningitidis triad?

A

fever

nuchal rigidity

altered mental status

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8
Q

What are the symptoms of meningitis in neonates?

A

hypotonia, irritability, poor feeding

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9
Q

What is Kernig’s sign?

A

have patient laying flat & you flex the hip up to 90 degrees & slowly extend the knee - (+) is if knee cannot be fully extended

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10
Q

What is Brudzinski’s sign?

A

have kid laying down on back, passively flex neck - (+) flexion in both legs

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11
Q

What is the last layer you will encounter when doing a lumbar puncture before reaching the epidural space?

A

ligamentum flavum

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12
Q

What are the characteristics of a CSF profile for bacterial meningitidis?

A
  • bacterial
    • high WBC (neutrophilic predominant)
    • low glucose & high protein
    • often be cloudy / yellowish
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13
Q

What is the treatment for suspectied bacterial meningitis?

A
  • supportive
  • empiric treatment
    • meningoencephalitis - corticosteoids & antibiotics and acyclovir
  • monitor for seizure (if indicated)
  • manage intracranial hypertension (if indicated)
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14
Q

What drug should be given prior to first antibiotic dose to reduce hearing loss & mortality?

A

dexamethasone (10mg)

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15
Q

What is the recommented antimicrobial therapy for H. influenzae type b?

A

3rd generation cephalosporin

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16
Q

What is the recommented antimicrobial therapy for N. meningitidis?

A

3rd generation cephalosporin

17
Q

What is the recommented antimicrobial therapy for Streprococcus pneumoniae?

A

vancomycin + 3rd generation cephalosporin

18
Q

What is the recommented antimicrobial therapy for Listeria monocytogenes?

A

ampicillin or penicillin G

19
Q

Who are “close contacts” that should receive prophylaxis in the case of a patient with bacterial menigitidis?

A
  • houselhold or day-care members who sleep or eat in the same dwelling as index patient
20
Q

In what cases do healthcare workers receive chemoprophylaxis for a patient with bacterial meningitis?

A

if they come in close contact whith the patient’s secretions (ie. mouth to mouth resuscitation)

21
Q

What is the antibiotic prophylaxis for contacts of patients with H. influenzae meningitis?

A

rifampin 10mg/kg 2x/day for 4 days

22
Q

What is the antibiotic prophylaxis for contacts of patients with N. meningitidis meningitis?

A

rifampin 10mg/kg 2x/day for 2 days

OR

single 500mg ciprofloxacin

23
Q

Since rifampin & ciprofloxacin is contraindicated in pregnant women, this population should take what for meningitis prophylaxis?

A

single 250mg dose ceftriaxone

24
Q

What is the causative agent & symptoms of Lyme Disease?

Treatment?

A

borrelia burgdorferi

affects skin, heart, nerves & joints

doxycycline

25
Q

What are the characteristics of the first stage of lyme disease?

A

eyrthema migrans “bulls eye”

flu-like symptoms (headache, malaise, fatigue, or myalgias)

26
Q

What are the characteristics of the Stage 2: Early Disseminated Lyme disease?

A
  • acute neuroborreliosis - weeks, months
  • malaise, fatigue, lymphadenopathy
  • nervous system
    • meningeal signs (headache, neck stiffness, difficult concentrating, cranial nerve dysfunction, radiculopathies, ataxia)
  • cardiac system
    • A-V block, myopericarditis, pancarditis
  • lyme arthritis
27
Q

What are the characteristics of Stage 3: Late Chronic Lyme Diseae?

A
  • nervous system & joints continuous inflammation > 1 yr
  • cognitive changes & fatigue
  • lyme encephalopathy, polyneuropathy & leukoencephalopathies
  • chronic arthritis
  • lymphocytoma; acrodermiatis, chronica atrophicans
28
Q

What is the causitive agent & treatment for neurosyphilis?

A

Treponema pallidum

Penicillin G

29
Q

What are the 5 types & characteristics of Neurosyphilis?

A
  • Syphilitic
    • weeks - years after infection (Argyll Robertson pupil; CN)
  • Meningovascular
    • 7-10yrs after infection (prodromal symptoms, psychiatric abnormalities, paraplegia, arteritis, stroke)
  • General paresis
    • 3-30 yrs after infection (chronic dementia, Argyll pupil, delusions, change in personality)
  • Tabes dorsalis
    • 5-50 yrs after infection (vision loss, losso of reflexes, sensory gait, loss of tracts of posterior columns- proprioception & vibration)
  • Gumma
    • soft, non-cancerous, granulomatous growth
30
Q

What is Argyll Robertson pupil?

A

constricts with accomodation but not reactive to light

31
Q

Where is Histoplasmosis geographically found?

A

Ohio, Missippi River Valley, caves

32
Q

Where is Coccidiodes immitis demographically found?

A

Southewestern USA, Northern Mexico

33
Q

Where is Cryptococcus neoformans demographically found?

A

bird droppings, soil, decaying wood

34
Q

What is the first-line treatment for fungal meningitis?

2nd line?

A

Amphotericin B

2nd - Fluconazole

35
Q

What is the most common cause of meningitidis in patients with AIDS?

A

Cryptococcus neoformans

36
Q

What parasitic infection is one of the most common causes of acquired epilepsy in the world?

How is it acquired?

A

Taenia solium

ingestion eggs of pork tapeworms (incubation months - years)

Neuro II (30 decks)

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