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Clin Med IV - Geriatrics & Neuro > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Most common causes of meningitis

A
  • Bacterial (acute bacterial meningitis)

- Viral (aseptic meningitis)

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2
Q

Most common pathogens of ABM

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Haeomphilus influenza type B
  • Group B Streptococcus
  • Listeria monocytogenes
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3
Q

Most common causes of viral meningitis

A
  • ENTEROVIRUS**
  • HSV
  • Lymphocytic choriomeningitis virus
  • VZV
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4
Q

Aseptic bacterial pathogens that cause meningitis

A
  • M. tuberculosis
  • Lyme*
  • Trepenoma
  • Ehrlichia
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5
Q

Drug-induced causes of non-infectious meningitis

A
  • Bactrim
  • Ciprofloxacin
  • Flagyl
  • Amoxicillin, penicillin
  • Keflex
  • NSAIDs
  • Ranitidine
  • Carbamazepine
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6
Q

2 broad categories of non-infectious causes of meningitis

A
  • Drug-induced

- Systemic

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7
Q

Cardinal sx’s of ABM (4)

A
  • Fever**
  • Headache
  • Nuchal rigidity
  • Altered mental status

2/4 found in almost all ABM cases

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8
Q

What special PE tests would support ABM dx?

A

Positive Brudzinski and Kernig’s signs

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9
Q

33% ABM pts present with dysfunction in these CNs

A

III
VI
VII
VIII

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10
Q

How does aseptic meningitis differ from ABM?

A

More benign course, self-limited → symptomatic support

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11
Q

Risk factors for meningitis

A
  • Age >50
  • URI, otitis media, sinusitis, mastoiditis
  • Head trauma, neurosurgery
  • Crowded living conditions
  • Immunocompromised
  • Antivacciners
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12
Q

Labs for ABM

  • WBCs
  • Glucose
  • Protein
A
  • WBC’s elevated w/ neutrophilic shift
  • Decreased glucose
  • Elevated protein
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13
Q

Labs for viral meningitis

  • WBCs
  • Glucose
  • Protein
A
  • WBC’s elevated, lymphocytic
  • Glucose normal
  • Protein elevated
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14
Q

Labs for fungal meningitis

  • WBCs
  • Glucose
  • Protein
A
  • WBCs elevated, lymphocytic
  • Glucose normal to decreased
  • Protein elevated
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15
Q

Labs for tuberculosis meningitis

  • WBCs
  • Glucose
  • Protein
A
  • WBCs elevated, lymphocytic
  • Glucose decreased
  • Protein elevated
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16
Q

Lactate _____ is associated with mortality in meningitis

A

> 4

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17
Q

When should blood cx be obtained for meningitis?

A

BEFORE abx

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18
Q

Definitive test for diagnosing meningitis

A

Lumbar puncture

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19
Q

CSF findings in LP for meningitis

A
  • Elevated opening pressure (>20mmHg)

- WBC >500 more likely bacterial source, but some do have lymphocytic shift early on

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20
Q

When should head CT be performed when diagnosing meningitis?

A

Before LP, if concerned for increased ICP

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21
Q

Indications for obtaining head CT before performing LP for meningitis

A
  • Abnormal mental status
  • Seizure within 1 week of presentation
  • Known CNS disease/lesion
  • Focal neuro findings
  • Papilledema
  • Age >60
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22
Q

When should abx be given to treat meningitis?

A

BEFORE LP/CT if high suspicion for ABM (still got some time before the CSF becomes affected)

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23
Q

How long do you have to obtain LP after giving abx in suspected ABM?

A

Within 2-4 hours

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24
Q

Tx meningitis

A
  • Abx (based on age, predisposing condition) if ABM suspicion
  • Dexamethasone prior to or with abx**
  • Antivirals if suspicious for viral etiology
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25
Q

How should you treat elevated ICP?

A

Mannitol, mild hyperventilation, neurosurgery consult. Consider hypertonic saline

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26
Q

What should you use to tx ABM in age 16-50?

A

Vanco + 3rd gen. ceph (e.g. ceftriaxone)

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27
Q

What should you use to tx ABM in age >50?

A

Vanco + 3rd gen. ceph. + ampicillin

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28
Q

What organisms would you suspect in ABM for age 16-50?

A
  • N. meningitidis
  • S. pneumoniae
  • H. influenzae
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29
Q

What organisms would you suspect in ABM for age >50?

A
  • N. meningitidis
  • S. pneumoniae
  • Listeria
  • Aerobic G- bacilli
30
Q

What should you use to tx ABM in immunocompromised pts?

A

Vanco + 3rd gen ceph. + ampicllin

31
Q

What organisms would you suspect in ABM for immunocompromised?

A
  • N. meningitidis
  • S. pneumoniae
  • Listeria
  • Aerobic G- bacilli
32
Q

What should you use to tx ABM in pts w/ neurosurgery or recent head/cerebrospinal trauma?

A

Vanco + 3rd gen ceph. + anti-pseudomonal
OR
Vanco + meropenem

33
Q

Management for likely viral meningitis

A
  • Admit and treat w/ IV abx while awaiting CSF cx (24 hrs)

- If confident and pt comfortable/reliable can discontinue with 24-48hr follow up +/- single dose abx

34
Q

Most common etiologies of encephalitis

A
  • Direct viral invasion

- Delayed hypersensitivity reaction to virus or other foreign protein several weeks s/p exposure

35
Q

Most common viruses that cause encephalitis via direct viral invasion

A
  • Enterovirus

- HSV

36
Q

Most common viral cause of encephalitis worldwide

A

Measles

37
Q

How would you diagnose encephalitis secondary to hypersensitivity reaction?

A

CSF has no viral proteins

38
Q

Presentation of encephalitis

A
  • Altered mental status**
  • Fever
  • Headache
  • HPI of mild flu or febrile viral illness w/ possible evidence of meningeal involvement
39
Q

Risk factors for encephalitis

A
  • Age (young/old)
  • Immunocompromised
  • Geographic location
  • Travel
  • Outdoor activity
  • Season
  • Immunization
40
Q

Dx encephalitis

A

Clear, cloudy, turbid, bloody CSF

  • Opening pressure >20mmHg
  • Slightly elevated protein
  • Pleocytosis w/ lymphocytic predominance
  • Normal glucose
  • Negative gram stain, culture
  • PCR*
41
Q

Findings of HSV on head neuroimaging

A

Focal edema in orbitofrontal and temporal areas

42
Q

Findings of WNV, EEE on head neuroimaging

A

Demyelination in basal ganglia and thalamic areas

43
Q

Tx encephalitis

A
  • Acyclovir (even before CSF results if suspected)
  • Supportive tx → suppress fever, ICP monitoring, fluid restrict, SIADH/hypoNa+
  • Benzos/anticonvulsants ppx for seizure
  • If elevated ICP → mannitol or hypertonic saline, neurosurgery consult
44
Q

Arbovirus method of transmission

A

Through vector (e.g. mosquito)

45
Q

Where is West Nile Virus found?

A

All states in summer, early fall

46
Q

Greatest risk for WNV is _____

A

Elderly

47
Q

Most cases of WNV are mild and clinically unapparent with ____ days of sxs and ____ days of incubation

A

3-6 days sx

3-14 days incubation

48
Q

Dx WNV

A

CSF or serum for WNV IgM 3-5 days s/p exposure → positive up to 3 months

May have to repeat if 1st sample negative

49
Q

Epidemiology of fatal LaCross encephalitis

A

Age <16

50
Q

Epidemiology of Eastern Equine encephalitis

A

Eastern/Central states (none in MA, VT)

51
Q

Epidemiology of Japanese encephalitis

A

Travelers (ppx vaccine available)

52
Q

How is rabies transmitted?

A

Infected vector to humans by saliva or brain/nervous tissue to mucous membranes, eyes, nose, mouth, open wound

53
Q

Incubation period for rabies

A

2-8 weeks before sx’s develop

54
Q

Tx rabies exposure

A

Post-exposure ppx even in cases w/out direct contact

  • Passive → rabies IG injection x1 around wound
  • Active → HDCV IM days 0,3,7,14

No treatment if rabies develops → ~100% fatal

55
Q

What animals might you specifically be concerned of contracting rabies from?

A
  • Raccoon
  • Fox
  • Coyote
  • Skunk
  • Brown bats
56
Q

Are small rodents able to transfer rabies to humans?

A

No

57
Q

What should you do if you suspect a domestic animal has rabies?

A

10-day observation/quarantine → rabid demeanor reveals itself within this time

58
Q

Should you be concerned your pet has rabies?

A

Not really… vaccines are pretty good here (not so much in other countries)

59
Q

Tx paraneoplastic or autoimmune encephalitis

A
  • IVIG
  • Methylprednisolone
  • Early tumor resection if applicable
60
Q

90% epidural abscesses occur where? Why?

A

Spinal, esp. thoracolumbar region - dura is adherent to skull

61
Q

Etiology of intracranial epidural abscess

A
  • Sinusitis
  • Orbital cellulitis
  • Skull fracture
  • Neurosurgery
62
Q

Presentation of intracranial epidural abscess

A
  • Fever
  • Headache
  • Malaise
  • Lethargy
  • N/V
63
Q

Risk factors for epidural abscess

A
  • DM
  • ETOH
  • Trauma/surgery
  • IVDA
  • CKD
  • Immunosuppression
  • Anesthesia/injections
  • Pregnancy
64
Q

Tx intracranial epidural abscess

A
  • Craniotomy to dran abscess

- Vanco + 3rd/4th ceph +/- Flagyl

65
Q

Common locations of spinal epidural abscess

A

Thoracic > Lumbar > Cervical

66
Q

Etiologies of spinal epidural abscess

A
  • Hematogenous spread**

- Direct extension

67
Q

4 stages of spinal epidural abscess manifestations

A
  • Fever + local back pain
  • Radiculopathy d/t nerve root compression
  • Spinal cord compression → cauda equina, motor/sensory deficits, saddle anesthesia, ecr. DTRs
  • Paralysis
68
Q

LP should be performed in spinal epidural abscess. T/F

A

No!

69
Q

Diagnostic of choice for spinal epidural abscess

A

MRI (or CT)

NO LP

70
Q

Tx spinal epidural abcess

A
  • Consult neurosurgery, spine surgery, ID → early surgical decompression/drainage w/ laminectomy within 24 hrs
  • May attempt CT-guided drainage if neuro deficits
  • Vanco + 3rd/4th ceph. +/- Flagyl → taylor to cx results

Clin Med IV - Geriatrics & Neuro (2 decks)

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