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Neuro. CM3 > CNS Infections > Flashcards

CNS Infections Flashcards

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1
Q

Name of two leptomeninges:

A

Arachnoid and Pia mater

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2
Q

What has lead to the decrease of meningitis rates?

A

Conjugate vaccines

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3
Q

Where does meningitis infection take place?

A

Subarachnoid space - No immune protection here

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4
Q

Organism that causes highest mortality of meningitis:

A

S. pneumoniae - 20%

*Droplet spread

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5
Q

Organism with <10% mortality:

A

N. meningitidis

*Intimate contact

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6
Q

Organism with 5% mortality:

A

H. flu

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7
Q

Contagious spread from rarer adjacent spreads: (3)

A

OM or sinusitis (rare)
Trauma or Post-op infection
Indwelling devices (CSF shunts)

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8
Q

What causes leaking of albumin and vasogenic brain edema?

A

LPS on gram negative and cell wall on gram positive –> inflammation –> leaky BBB

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9
Q

If a patient is immunosuppressed or is on low dose steroids (vasculitis, RA, transplant) they have what organism:

A

Cryptococcus neoformans

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10
Q

TB infection can cause:

A

Chronic meningitis

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11
Q

Anatomic or functional asplenia exposes you to (3):

A

The three encapsulated organisms that cause meningitis: S. pneumonia, N. meningitidis and H. flu

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12
Q

Pregnant women may have what bug:

A

L. monocytogenes (listeria)

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13
Q

Facial or skull trauma may cause for you to get this bug:

A

Staphylococcus species

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14
Q

Children are at risk for meningitis from what bug:

A

S. pneumonia that is penicillin-resistant

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15
Q

Acute meningitis develops within:

A

Hours to days

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16
Q

Subacute meningitis develops over:

A

More than one week

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17
Q

What is subacute meningitis usually caused by? (3)

A

Mycobacterium, fungi or B. burgdorgeri (Lymes)

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18
Q

Chronic meningitis usually lasts: months to years and is causes by:

A

TB or Syphilis (T. pallidum)

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19
Q

Meningioencephalitis involves both the leptomeninges and the brain parenchyma. Causes by (2):

A

HSV or arbovirus (mosquito > tick)

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20
Q

Seizing is a big problem in what category of meningitis?

A

Meningoencephalitis

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21
Q

What is parameningeal infection?

A

Abscess, tumor that mimics symptoms of meningitis

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22
Q

Pre-term - 1 month: Causative bacterial agent is (3):

A

S. agalactiae (GBS)*
E. coli
Listeria

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23
Q

Over 1 month - 50 years: Causative bacterial agent is (3):

**Vaccination offers protection

A

S. pneumonia and N. meningitidis

*H. flu is rare

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24
Q

What two viruses causes 95% of pediatric meningitis:

A

Arboviruses
Enteroviruses
*ASEPTIC

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25
The 4 medications that can cause aseptic meningitis:
- TMP-SMX - Ibuprofen - Metronidazole - Lamotrigine - Bipolar
26
If you think you have a drug induced meningitis syndrome what do you do?
Stop medication, re-test the CSF
27
___ meningitis is most common
Viral
28
The signs and symptoms of meningitis are most often caused by:
The immune system not the bug itself
29
CN palsies possible with meningitis
4, 6, 7
30
Symptoms of meningitis (6):
- HA - Fever - N/V - Photophobia - Increased ICP - Brady, HTN, papilledema - Seizures/CN palsies
31
The Kernig and Brudzinski test are:
Not sensitive but are highly specific
32
Range or the Glascow coma scale:
3 - Lowest (bad news) | 15 - Highest
33
What is purpura fulminans
Mengococcemia - Starts as URI symptoms and progresses to the rash (can be in a day)
34
Tests you order for Meningitis (5) 3C's, B, L:
- CBC with diff - CMP - Coagulation and platelets if alcoholic - Blood cultures - Lumbar puncture (4 tubes)
35
What are the four tubes for the lumbar puncture:
1. Glucose and protein 2. Cell count with differential 3. GS and bacterial 4. Repeat and future studies
36
What is the VDRL test?
Neurosyphilis
37
What would you order to test for TB?
AFB stain
38
What would you order if you suspected crypto coccus neoformans?
Cryotococcal antigen
39
When do you not do a LP?
If someone comes in with back pain AND meningitis symptoms - could be an epidural abscess
40
Medication for viral meningitis:
Acyclovir
41
What is the ME panel?
Tests meningitis and encephalitis (yeast - crypto neoformans), viruses and bacteria)
42
What will be high on labs if bacterial meningitis?
- High opening PSI - High cell count - PMNs - High protein
43
What will be high on labs if viral meningitis?
- High Lymphs **All else is LOW
44
Strep pneumoniae morphology:
Gram positive lanceolate diplococci
45
Neisseria meningitidis morphology:
Gram negative coffee bean diplococci
46
H. Flu morphology:
Brat-like gram negative rods/coccobacilli
47
Listeria Monocytogenes morphology:
Gram positive SMALL rod
48
If you do an LP and get pus:
Epidural abscess - BAD
49
Most common SE of a LP (10 - 30% of patients):
Headache - Frontal/occipital (will improve in 12-24 hours)
50
HA post LP improvement with what position:
HA improves in the supine position
51
Treatment of post LP HA: (2 steps):
1. Bed rest + oral analgesics (opioids if necessary) | 2. Epidural blood patch - autologous blood injected at site of LP (volume replacement)
52
CT SCANS ARE ___for meningitis treatment
Not needed for meningitis right away and delay treatment
53
It takes ___ hours before the ABX for meningitis would affect a LP result
6 hours
54
If you get a head CT before a LP, also get __
Two sets of blood cultures and start treatment immediately (2 IVs)
55
Who should get a CT before a LP? (6) HANNIP
HANNIP: - History of stroke/lesion - Abnormal level of consciousness - New onset seizure (within 1 week) - Neuro déficit - dilated pupil, gaze palsy etc. - Immunocompromised - Papilledema
56
What is started ASAP for a patient with meningitis in the ED?
- 1 shot dexamethasone | - Vanco. + 3rd gen cephalosporin (ceftriaxone)
57
Isolation for meningitis:
Droplet
58
ABX for meningitis must have these characteristics (3):
- Bacteriocidal - ABX that penetrates the CSF - Go after MRSA
59
If you think the patient has meningitis from listeria, add what medication?
Ampicillin
60
If steroids or given, how should they be given?
WITH or slightly before the ABX | - 0.15 mg/kg IV q6 hours x 4 days
61
How long do you treat for? Meningitis --> Pneumococcal --> Listeria
1. Meningococcal: 5 - 7 d 2. Pneumococcal: 10 - 14 d 3. Listeria: Minimum of 21 d
62
Three vaccines available to prevent meningitis:
1. Pneumococcal 2. HIB 3. Meningococcal
63
MENGIOCOCCAL ONLY: Treatment for those exposed to oral secretions or respiratory droplets >8 hours duration before symptom onset (3 options):
1. Ceftriaxone (250 mg IM x1) 2. Ciprofloxacin (500 mg PO x1) 3. Rifampin ( 600 mg PO q12 X2d)
64
If exposed to pneumococcal meningitis, what can you give?
Nothing is recommended
65
What is most common of meningitis and encephalitis?
Meningitis > Encephalitis | Aseptic > Bacterial
66
Most common cause of sporadic fatal encephalitis in the US all year long:
HSV
67
If a patient has HSV-2 they also may have:
Herpetic lesions on there genitals
68
What lobe of the brain does HSV like to hit?
Temporal
69
What are three later signs of an HSV encephalitis?
- Word salad - Impaired memory - Loss of emotional control - Naked woman around the house
70
What are the three findings in CSF for HSV encephalitis?
1. Increased RBC - May be hemorrhagic 2. Increased protein 3. Lymphocytic pleocytosis
71
Test for HSV by sending it for (when is it positive):
PCR - positive within 1st 24 hours of symptoms
72
MRI findings for HSV +:
Unilateral temporal mass effect or changes
73
Treatment of HSV encephalitis:
All ABX for bacterial meningitis + IV acyclovir (can stop the ABX when you are SURE it is not bacterial)
74
Arbovirus encephalitis - Know ___
Flaviviridae - West NIle
75
What tick is the Arbovirus encephalitis transmitter?
Deer dick
76
#1 cause of epidemic encephalitis in the US
West Nile virus - Flaviviridae
77
Indicator of WNV in the US:
Dead birds (ravens and jays)
78
Symptoms of WNV:
3-6 days (flu-like)
79
What are the two serious things you can develop with WNV?
- Polio-like paralysis (ascends - legs don't work first) | - Mengioencephalitis or aseptic meningitis
80
Testing for WNV:
Serum WNV for CSF (IgM) OR PCR - use the fourth tube
81
Most common prion disease:
CJD
82
Average age of CJD:
60 YO
83
Most common cause of CJD (80%):
Sporadic
84
What is Kuru?
Endocanabilism (W > M) can cause CJD
85
Two categories of clinical findings in CJD:
1. 100% cognitive (fast onset dementia) | 2. 60% psychiatric (anxiety, euphoria etc.)
86
Someone with CJD may have this when you scare them(80%):
Startle sensitive myoclonus
87
Special test for CJD:
LP for CSF - RT-QulC assay/14-3-3-3 **CALL THE LAB - this can ruin equipment
88
What two imaging studies will reveal abnormalities for CJD?
EEG and MRI
89
Prognosis of CJD
Death within 1 year - no Tx.

Neuro. CM3 (11 decks)

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