Encephalitis, meningitis Flashcards
(37 cards)
How do pts w/ encephalitis present?
- Fever
- Altered mental status
- Seizures
- Focal neuro sx
What do you see on PE for encephalitis?
- Papilledema
- Rash
- Autonomic & hypothalamic disturbances
- Arthritis
- Retinitis
What imaging do you use for dx of encephalitis?
- MRI > CT
- Start w/ CT w/out contrast if pt is SICK (faster, r/o mass lesion)
- MRI: hyperintensity in areas of edema
What are contraindications to doing a lumbar puncture?
- Si/sx of increased ICP
- Severe coagulopathy
- Skin infection
- Mass lesion
- If pt has any of the above, CT > LP
What makes up cushing’s triad?
- Respiratory depression
- Bradycardia
- HTN
* Seen in encephalitis
What is cloudy CSF indicative of?
Bacterial meningitis
What are other causes of elevated WBCs in lumbar puncture sample?
- Vasculitis
- Leukemic infiltration
- Traumatic tap*
What is the gold standard for dx of encephalitis?
Brain biopsy
- Invasive, not the initial test performed
How do you tx encephalitis?
- Stabilize (ET tube, vent, circulatory support)
- Antiviral therapy*
- Tx offending agent
- Prevent secondary bacterial infections, DVT, GI prophylaxis.
How can you tx increased ICP?
- Elevate head to 30-45˚
- Avoid compression to jugular veins
- Hyperventilate
- Corticosteroids & mannitol
What is empiric therapy for encephalitis? What is the % of survival?
Start Acyclovir (early): decreases morbidity/ mortality - Up to 90% survival
How do you prevent encephalitis?
Avoid vectors!
- Bug spray, barriers, avoid areas/times when mosquitos are active
What are classic sx of meningitis?
- HA
- Photophobia
- N/V
- Neck stiffness
- Fever
What are complications of bacterial meningitis?
If not fatal, can cause:
- neurological sequelae
- brain damage
- hearing loss
- learning disabilities
What are characteristics of “viral” meningitis?
- Aseptic
- Often indistinguishable from bacterial meningitis based on presentation alone
- Course usually self-limited
- # 1 cause = entero
What is the typical CSF analysis for “viral” meningitis?
- Colorless
- Can be cloudy
What is the typical CSF for encephalitis?
Straw-colored
How do neonates acquire “bacterial” meningitis?
From birth canal
Suspected bacterial meningitis = ________
EMERGENCY
What is the #1 pathogen causing “bacterial” meningitis in neonates?
Group B streptococcus
1 cause of bacterial meningitis in babies/children?
strep pneumoniae
1 cause of bacterial meningitis in teens & young adults?
Neisseria meningitidis
1 cause of bacterial meningitis in adults?
streptococcus pneumoniae
What organism do you need to test for in pregnant women? At how many weeks should you perform?
GBS
35-37 wks gestation
