CNS infections, concussion Flashcards by Brad Stone

Meningitis inflammation of what?

Meninges of brain of spinal cord

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2 types of Meningitis

Bacterial and Aseptic

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MC Etiology of acute bacterial Meningitis?

S Pneumoniae

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Where is Meningitis bacteria and how it penetrate?

Encapsulated bacteria in naso-oropharynx which penetrated intravascular space

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Most sensitive sign on bacterial Meningitis?

Fever

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Kernig’s Sign in Meningitis

Can’t straighted knee with hip flexion

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Brudzinski’s sign in Meningitis

Neck flexion produces knee/hip flexion

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Are Brudzinski and Kernig signs sensitive for Meningitis?

No!

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Neck and light in bacterial Meningitis

Nuchal rigidity, photosensitivity

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HA in bacterial Meningitis?

“Dull”, described unlike others

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Onset of sx in Meningitis?

Rapid over 24h

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Definitive dx in Meningitis?

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What to do and check before LP in Meningitis?

CT! Check ICP and brain shifting. LP can reduce pressure too quickly and cause herniation.

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Where to do LP in Meningitis?

Laying down, L3 and below (corda equina).

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How much CSF to draw for analysis in Meningitis?

4-8mL for PCR

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Glucose level in bacterial Meningitis?

Markedly decreased (<40)

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If glucose normal on LP in Meningitis then what etiology?

Viral

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Viral Meningitis d/t enterovirus in which seasons?

Summer/early fall

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What is most common Meningitis

Aseptic d/t enterovirus

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Petechial rash in bacterial Meningitis d/t which bacteria?

N Meningitidis

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Tx of bacterial Meningitis 18-50y/o

Ceftriaxone + Vancomycin

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Tx of bacterial Meningitis if >50 y/o?

Amp + Ceft + Vanco

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When to give steroids in bacterial Meningitis?

Prior or with abx!

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Tx for elevated ICP?

Mannitol, mild hyperventilation, hypertonic saline

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Tx for viral Meningitis?

Antivirals, symptomatic outpatient care

Encephalitis inflammation of what?

Brain parenchyma

Encephalitis etiology?

Viral. HSV and Enterovirus MC in immunocompetent. Measels MC in world.

Encephalitis virus causes what sort of reaction?

Hypersensivitiy reaction

Which brain matter affected more in Encephalitis?

Gray matter more than white

Class sx of Encephalitis?

Fever, HA, AMD

Encephalitis sx speed of onset?

Rapid

What is Primary Manifestation of Encephalitis?

URI sx, kinda sick

When is Secondary Manifestation of Encephalitis?

1-3 weeks after URI

Dx of Encephalitis?

CSF or serum WNV IgM Ab. Can be positive 1-3 months.

Tx for Encephalitis?

Supportive. Acyclovair 10mg/kg IV q8h.

Vector of Rabies Encephalitis?

Mammals. Raccoon, fox, coyote, skunks.

Which animals are not vectors for Rabies Encephalitis?

Small rodents

How long incubation until sx in Rabies Encephalitis?

2-8wk

Tx of Rabies Encephalitis?

Prophylaxis if rabid animal

Major manifestation of autoimmune Encephalitis?

Psych manifestations

Tx for autoimmune Encephalitis?

Immunosuppressants. | -IVIG, IV Methylprednisolone

Define concussion

Brain injury with complex pathological process affecting the brain, induced by trauma biochemical forces. From direct or indirect blow.

Hallmark of concussion sx?

Confusion and amnesia

Concussion functional or structural disturbance?

Functional

Sx from frontal concussion?

Irritability, inappropriate tearfulness

Sx from parietal concussion?

HA, nausea

Sx from occipital concussion?

Dizzy, disequilbrium, visual sx

When does Secondary Injury manifest in concussion?

Minutes to hours

When does Secondary Injury occur in concussion?

Happens immediately

concussion Secondary Injury d/t what?

Neurochemical cascade

4 categories of concussion sx?

1. Physical 2. Cognitive 3. Emotional 4. Sleep

Dx for concussion?

Clinical. No diagnostic test.

Sideline evaluation of concussion called?

SCAT3=13+ y/o | Child SCAT=5-12 y/o

Maddocks questions assess what?

Neuropsych. Part of SCAT3.

BESS tests for what in concussion?

Balance test at rest and then exertional if rest is normal.

What is GCS immediately after concussion injury? When improve to 15?

3-15. Improve to 15 w/n 2h.

ER tests for concussion? How long to observe?

Neuro exam q30min. Observe 4h.

When to Non-Con CT concussion?

Only if LOC or amnesia with neuro deficit or sx. Does not reveal concussive brain injury and not routinely performed.

Tx goal of concssion?

Minimize imbalance of energy supply and demand at brain cellular level

Rest until when in concussion? About how long?

Until ASx. About 7 days.

2 types of rest in tx of concussion

Cognitive and physical rest

Avoid daily activites which do what in concussion tx?

Increase HR

Tx HA in concussion?

NSAIDs and APAP

Nausea tx in concussion?

Zofran (SE=HA, drowsy)

Tx of sleep disturbances in concussion?

Good sleep hygiene, melatonin, trazadone

How long to concentrate on tasks with return to learn in in concussion?

30-45min

When can return to play in concussion?

When tolerate full school day without sx!

Minimum of how many days before return to competitive play in concussion?

Define Post Concussion Syndrome

Physical, cognitive, emotional, and sleep sx which persist beyond 4-6wk post-concussion

Does severity of concussion injury correlate with Post Concussion Syndrome?

Tx for pych and cognitive sx in Post Concussion Syndrome?

donezapil, psychotherapy, antidepressants, anoxiolytics, methylphenidate

Tx for HA in Post Concussion Syndrome?

Amitriptline

What is Second Impact Syndrome?

Death or devastating neurological injury due to massive brain swelling when second head injury occurs before full recovery from first

What happens to brain in Second Impact Syndrome?

Massive swelling

When does Second Impact Syndrome happen?

Second head injury occurs before first heals

Mortality rate in Second Impact Syndrome?

50%

Most used and valid computerized concussion evaluation system?

imPACT testing

When it imPACT testing done?

Baseline and q2y, again immediate post-concussion

Who does Chronic Traumatic Encephalopathy occur in?

Atheletes who suffer multiple concussions over course of career

Are mood, behavior, congitive, and somatic sx permanent in Chronic Traumatic Encephalopathy?

Yes they are permanent

Which protein builds up in Chronic Traumatic Encephalopathy?

Tau protein

Tau protein associated with what old age dz?

Alzheimers

What are two severe sx from Chronic Traumatic Encephalopathy?

1. Parkinson symptoms | 2. Dementia

Dx for Chronic Traumatic Encephalopathy?

PET

CNS infections, concussion Flashcards

(84 cards)