CNS Infections - Brain Abscesses and Other Infections (28) Flashcards Preview

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Flashcards in CNS Infections - Brain Abscesses and Other Infections (28) Deck (22):
1

Different types of primary bacterial infections in CNS

- Meningitis
- Encephalitis
- Ventriculitis
- Brain abscess
- Ventriculoperitoneal shunt and external ventricular drain infection
- Subdural empyema
- Eye infections

2

Brain abscess

Focal suppurative process within brain parenchyma (pus)

3

Causes of brain abscesses

Polymicrobial, streptococci (strep milleri 60-70%), staph aureus (10-15%), anaerobes, gram neg enteric bacteria (E.coli), fungi, M TB, Toxoplasma gondii, Nocardia, Actinomyces

4

4 pathogenesis of brain abscesses

1. Direct spread from 'contiguous' suppurative focus
2. Haematogenous spread
3. Trauma
4. Cryptogenic

5

Direct spread from 'contiguous' suppurative focus

Ear (40%), sinuses, teeth

6

Haematogenous spread from distant focus

Endocarditis, bronchiectasis (multiple abscesses)

7

Trauma

Open cranial fracture, post-neurosurgery

8

Cryptogenic

No identifiable reason

9

Clinical presentation

Headache, focal neurological deficit, confusion, fever (

10

Management

Drainage (treat 4-6 weeks antibiotics)

11

Antibiotics

Penetrate CSF/BBB
- Ampicillin, Penicillin, Cefuroxime, Cefotaxime, Ceftazidime, Metronidazole

12

Complications

Raised ICP, mass effect, coning, rupture (into ventricles) > ventriculitis

13

Subdural empyema

Infection between dura and arachnoid mata

14

Causes of subdural empyema

(Polymicrobial) anaerobes, streptococci, aerobic gram negative bacilli, streptococcus pneumonia, H.influenza, Staph aureus

15

Pathogenesis of subdural empyema

- Spread of infection from sinuses (50-80%), middle ear and mastoid (10-20%),
- Haematogenous 5%
- Following surgery/trauma

16

Clinical presentation subdural empyema

Headache, fever, focal neurological deficit, confusion, seizure, coma

17

Management of subdural empyema

Urgent surgical drainage of pus and antimicrobial agents

18

What is a ventriculoperitoneal (VP) shunt and external ventricular drain (EVD)?

Neurosurgical patients have it inserted into ventricles to monitor ICP/drain excess CSF

19

VP shunt and EVD infections

Colonised with bacterias > ventriculitis

20

Diagnosing VP shunt and EVD infections

CSF microscopy and culture

21

Most common cause of VP shunt and EVD infections

Coagulase-negative staphylococci

22

Treatment of VP shunt and EVD infections

Device removal, IV antibiotics

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