35 - CNS Infections Flashcards
(46 cards)
Two most common community acquired meningitis organisms?
strep pneumo (pneumococcus) neisseria meningitidis (meningococus)
Most common bugs for neonatal meningitis?
group B strep
E. Coli
Listeria
Most common bug for immuno suppressed or elderly meningtits?
listeria monocytogenes
Most common post-trauma meningitis?
staph aureus
Gram negatives (E. Coli)
Pneumococcus
How does meningococcus spread?
respiratory droplets (epidemics in tight quarters) three foot rule for bed spacing.
What can fulminant meningococcus cause (outside the brain)?
Waterhouse-Friderichesen syndrome - hemorrhagic necrotic adrenals
What is Kernig’s sign?
patient supine with hip flexed 90 degs, knee cannot be fully extended
What is Brudzinski’s sign?
passive flexion of neck causes flexion of both legs and thighs
A cyst in brain on autopsy is opened and reveals a dark fluid that looks like crank-case oil. Diagnosis?
Craniopharyngioma of Rathke’s pouch.
You suspect meningitis in a patient. CSF shows high PMN count and normal glucose. DIagnosis?
possibly a ruptured craniopharyngioma causing an acute chemical meningitis.
What usually happens to serum Na levels in meningitis?
they drop becuase of accompanying septic shock and SIADH, there is water retention and increased ICP
What happens to INR and prothrombin time in meningitis?
they become elevated due to consumption of clotting factors in DIC
What happens to CRP in bacterial meningitis?
increased
What happens to procalcitonin level in bacterial meningitis?
increased.
If blood glucose is 100, what should normal CSF glucose be?
2/3 of blood so about 66.
What should be given first in bacterial meningitis?
steroids first! dexamethasone within 15 minutes of antibiotics.
Then give Vancomycin (for penicillin resistant pneumococcus),
a cephalosporin like ceftriaxone
ampicillin for listeria
doxycycline for rickettsia and rocky mountain spotted fever.
Acyclovir for viral
What adverse effect can meropenem have?
can cause seizures
What should be given to those who have been in close contact with a bacterial meningitis patient?
prophylaxis of rifampin or cipro
How does bacterial endocarditis present?
fever, delirium --> coma. Possible miningeal signs. Septic emobli to brain causing stroke, cerebritis with absecesses, mycotic aneurysm Splinter hemorrages olser's nodes janeway lesions roth's spots
What is the difference between olser’s nodes and janeway lesions?
olser nodes are painful/tender (ulcer = pain)
janeway is painless macule on palms or soles (maryjane = no pain)
Patient presents with headache that is worse upon lying down and present when waking up, papilledma and transient visual obscurations, seizures, focal neuro deficits, contrast CT or MRI ring enhancing lesion. Dianosis?
cerebral abscess
What spares the disk and destroys the bone: infection or tumor?
tumor destroys bone
infection destroys disk (NP)
Presentation of spinal epidural abscess
severe back pain, worse lying down, point tenderness fever and malaise bowel an bladder dysfunction paraparesis or quadriparesis sensory loss high SED rate, left shif of WBC
What is most common causitive organism for spinal epidural abscess?
Staph aureus
