S14C168 - CNS and Spinal Infections Flashcards
1
Q
Reasons to CT before LP:
A
- altered mental status, decreased LOC
- focal neuro deficit
- seizure
- papilledema
- immunocompromised state
- malignancy
- history of focal CNS dz (stoke, focal infxn, tumor)
- concern for mass lesion
- age >60y
2
Q
Tx meningitis 18-50yo
A
- ctx 2g q12h
- vanco 15mg/kg q8-12h
3
Q
Tx meningitis >50yo
A
- ctx 2g q12h
- ampicillin 2 q4h
- vanco 15mg/kg q8-12h
4
Q
Tx meningitis if hx of penetrating head trauma
A
- vanco
- ceftazidime
- or meropemenem
5
Q
Tx meningitis if PCN or cephalosporin allergy
A
- vanco
- moxifloxacin
- septra 10-20mg/kg divided q6-12h
6
Q
Tx meningitis if spread from sinusiti
A
- ctx
- flagyl
- surgical drainage
7
Q
For what meningitis pathogen do you give prophylactic Abx to contacts?
A
- n meningitidis
- close contacts in past 7d, those exposed to secretions or intubated the pt
- rifampin 10mg’kg (max 600mg per dose) q12h x4 doses
- OR ciprofloxacin
8
Q
Viral encephalitis: causes (North Am)
A
- arbovirus
- HSV 1
- HZV
- EBV
- CMV
- rabies
9
Q
Viral encephalitis: pathophys
A
- affects mostly gray matter
- causes cognitive and pxychiatric sx, lethargy, Sz
10
Q
Viral encephalitis: presentation
A
- new psyc Sx, cognitive deficits (aphasia, amnestic syndrome, acute confusional state), Sz, mvmt d/o
- also sx of meningeal involvement: h/a, photophobia, fever
11
Q
Viral encephalitis: Dx
A
- CT/MRI, EEG, LP
- HSV: involves medial and temporal and inferior frontal grey matter, pathognomonic EEG
- LP most useful after CT to r/o herniation
12
Q
Viral encephalitis: Tx
A
- acylovir for HSV/HZV
- ganciclovir for CMV
13
Q
Brain abscess: presentation
A
- h/a in almost all cases
- fever in 50% and neck stiffness
- may have focal neuro Sx, hemiparesis, Sz
- increased ICP: vomiting, confusion, obtundation
- meningeal signs present in 50%
- papilledema in 1/3 of pts
- Dx: CT with contrast (ring enhancing lesion)
