Meningitis and Encephalitis

Question 1

Even with ABx therapy & imaging, condition still carries a ~
___% mortality rate.

Answer 1

14

Question 2

Meningitis typically occurs through what two routes of inoculation?

Answer 2

(a) Hematogenous seeding
(b) Direct contiguous spread

Question 3

What route of meningitis inoculation?
Organisms enter CSF via neighboring anatomic structures (otitis media, sinusitis) or foreign objects (medical devices, penetrating trauma).

Answer 3

Direct contiguous spread

Question 4

What route of meningitis inoculation?
Bacteria colonize in nasopharynx & enter bloodstream. Upon making their way to the subarachnoid space, the bacteria cross the blood-brain barrier, causing a direct inflammatory and immune-mediated reaction.

Answer 4

Hematogenous seeding

Question 5

What is the Classic Meningeal Tetrad

Answer 5

Fever, nuchal rigidity, altered mental status, & severe headache

Question 6

True/False
However, the presence of all four signs of meningitis is necessary for clinical diagnosis;

Answer 6

False
patients may only have 2-3 out of the 4 signs.

Question 7

Meningitis
What should be done prior to lumbar puncture and CSF collection?

Answer 7

CT

Question 8

What comprises the foundation of meningitis management/treatment

Answer 8

Managing airway
maintaining oxygenation
sufficient IV fluids
controlling fever

Question 9

Meningitis Antibiotic Treatment:

Answer 9

(a) Ceftriaxone 2g IV Q12H x 7 days
(b) Pen-G 4 million units IV Q4H x 7 days

Question 10

Steroids
Administration of ________________ IV is associated with reduction in rate of hearing loss, neurologic complications, and decreased mortality rates.

Answer 10

dexamethasone 4mg

Question 11

Meningitis
Signs of ICP (altered mental status, neurologic deficits, non-reactive pupils, bradycardia), may require what

Answer 11

-Elevating the head of the bed to 30 degrees
-inducing mild hyperventilation in the intubated patient
-osmotic diuretics such as 25% mannitol or 3% saline (CALL MO)

Question 12

Chemoprophylaxis regimen for meningitis

Answer 12

a) Ceftriaxone 250mg IM one time
b) Ciprofloxacin 500mg PO one time

Question 13

Meningitis – Disposition

Answer 13

Medical Evacuation is indicated for any patient with suspected meningitis, regardless of etiology or status.

Question 14

Meningitis Differential Diagnosis

Answer 14

Stroke,
subdural hematoma,
subarachnoid hemorrhage,
metastatic brain disease,
brain abscess (may coexist with meningitis)