CNS Infection

Question 1

Menigitiis

Answer 1

acute inflammation of the leptomeninges due to bacteria growing within the CSF

Question 2

encephalitis

Answer 2

inflammation of brain parenchyma

Question 3

brain abcess

Answer 3

localized collection of pus within the brain parenchyma

Question 4

Pathogenesis of CSF infection

Answer 4

bacteremia, direct extension from (middle ear, mastoid bone, paranasal sinus, head wound)

Question 5

most common bacteria acute bacterial meningitis for neonates

Answer 5

Group B Strep, Listeria, enteric gram-negative rods

Question 6

most common bacteria acute bacterial meningitis for child

Answer 6

S. pneumoniae, N. meningitidis, H. influenzae

Question 7

most common bacteria acute bacterial meningitis for adult

Answer 7

S. pneumoniae, N. meningitidis

Question 8

sx of meningeal inflammation

Answer 8

stiff neck, HA

Question 9

sx of toxins

Answer 9

brain swelling, increased ICP, herniation, encephalopathy, seizure

Question 10

sx of inflammation of CN

Answer 10

nerve palsies

Question 11

sx of vasculitis/ thrombosis

Answer 11

brain infarcts

Question 12

sx of meningeal fibrosis

Answer 12

communicating hydrocephalus

Question 13

acute inflammatory process of acute bacterial meningitis can involve…

Answer 13

CN and BV within the subarachnoid space

Question 14

Meningitis common complications

Answer 14

seizures 20-50%

see: nerve palsy, monoparesis, hemiparesis, gaze preference

Question 15

rate of focal deficits is higher in adutls with ___ compared to other pathogens

Answer 15

pneumococcal meningitis

Question 16

workup for bacterial meningitis

Answer 16

LP: culture and workup the fluid - give strong abx

Question 17

pleocytosis

Answer 17

increased cell count, specifically an increase in white blood cell (WBC) count, in
the cerebrospinal fluid (CSF).

Question 18

leukocytosis

Answer 18

versus an increased white blood cell count in the blood

Question 19

with pleocytosis you will see mainly ___ with bacterial meningitis

Answer 19

neutrophils

Question 20

indications for imaging before LP

Answer 20

1. altered mental status
2. new focal neuro deficit( CN palsy, extremity weakness or drift, dysarthria, aphasia)
3. papilledema
4. seizure within past week
5. history of CNS disease - stroke, tumor
6. age 60+
7. IC state
8. high clinical suspicion for subarachnoid hemorrhage

Question 21

when do you start abx for meningitis?

Answer 21

if you suspect that do it empirically even before you do imaging/LP

Question 22

no imaging for suspected meningitis pt with ____ neuro exam and do not have ___

Answer 22

non-focal neurologic exam

do not have papilledema

Question 23

description of post mengitis leptomenigitis

Answer 23

mucus - purulent/ exudative

see tracking of pus around vessels

Question 24

what is common sequale of bacterial meningitis if pt has surved

Answer 24

fibrotic damage to subarachnoid space = communicating hydrocephalus
- get MR - radiation!

Question 25

subacute and chronic meningitis presents with

Answer 25

fever, headache, meningismus, and altered mental status similar to an acute meningitis

Question 26

subacute/ chronic meningitis onset is ___

Answer 26

gradual onset over weeks to months

Question 27

common organisms that cause subacute/chronic meningtis

Answer 27

mycobacteria (tuberculosis), fungi (cryptococcosis), and spirochetes (syphilis, Lyme disease).

Question 28

___ can also cause chronic meningitis

Answer 28

sarcoidosis

Question 29

___ is most common sporadic viral encephalitis

Answer 29

HSV1

Question 30

HSV1 encephalitis is very___

Answer 30

deadly = necrosis and hemorrhage in brain

Question 31

Viral meningitis has __ course

Answer 31

benign

Question 32

HSV1 hones to the

Answer 32

temporal lobe

Question 33

rabies hones to

Answer 33

anterior horn of spinal cord

Question 34

polio? hones to

Answer 34

spinal cord

Question 35

HSV-1 incites a very ___ picture

Answer 35

hemorrhagic picture - lesions are hemorrhagic and can shed RBC in CSF