Flashcards in EXAM #1: CNS INFECTIONS Deck (32):
1
What is the first thing to ask yourself with a patient that has a suspected CNS infection?
Duration
2
What is the second thing to ask yourself with a patient that has a suspected CNS infection?
Etiology
3
What is the third thing to ask yourself with a patient that has a suspected CNS infection?
Work-up
4
What is the fourth thing to ask yourself with a patient that has a suspected CNS infection?
Treatment
5
What are the four main types of infections that affect the brain?
1) Acute meningitis
2) Chronic meningitis
3) Brain abscess
4) Ecephalitis
6
What are the non-infectious etiologies of presentations similar to a CNS infection?
1) Neoplasia
2) Collagen Vascular Disorder
3) Medications
7
What are the routine tests done on a lumbar puncture?
1) WBC w/diff
2) RBC
3) Glucose
4) Protein
5) Gram stain
6) Bacterial culture
7) Opening pressure
8
What infectious etiology is associated with an elevated opening pressure?
Cryptococcal meningitis
9
What is xanthochromia?
Yellow supernantant of CSF from RBC lysis
10
What are the expected CSF findings in bacterial meningitis?
- 1000-5000 WBC
- 100-500 Protein
- Less than 40 glucose
- Neutrophils
11
What CSF findings are associated with tuberculous meningitis?
- 50-300 WBC
- Mononuclear
- Less than 45 glucose
- 50-300 Protein
12
What CSF findings are associated with viral meningitis?
- 50-1000 WBC
- Mononuclear
- Greater than 45 glucose
- Less than 200 protein
13
What are the CSF findings associated with Cryptococcal meningitis?
- 20-500 WBC
- Mononuclear
- Less than 40 glucose
- Greater than 45 protein
14
What imaging study is preferred for neuroimaging in the setting of CNS infection?
MRI
15
When is imaging warranted?
1) Persistent or prolonged fever
2) Focal neuro findings
3) Increased ICP
4) New/ recurrent seizure
5) Persistent dysfunction
6) Persistently abnormal CSF parameters
*An enlarging head circumference in a neonate
16
What are the characteristics of the antibiotic you want to give for acute bacterial meningitis?
1) Needs to CROSS the BBB
2) Must be BACTERIOCIDAL
17
What are the two most common causes acute bacterial meningitis?
1) Streptococcus pneumonaie
2) Neisseria meningititdis
18
What viruses are most viral meningitis?
1) Enterovirus
2) Herpes virus
19
What three pathogens are associated with subacute/ chronic meningitis?
1) M. tuberculosis
2) T. pallidum
3) Borrelia burgdorferi
20
What is the intracellular pathogen that can cause meningitis in the very young and old?
L. monocytogenes
21
How do you start off treating a patient with acute bacterial meningitis?
1) IV Vancomycin
2) Ceftriaxone
22
If a patient is very young or old and you're considering L. monocytogenes, what drug should you add?
Ampicillin
23
In a patient that has had neurosurgery, what pathogens should come to mind?
1) Coagulase negative S. species
2) Pseudomonas
*B/c this is part of the normal skin flora
24
What drug covers coagulase negative Staph species?
Vancomycin
25
What drug do you need to use to cover for Pseudomonas?
Ceftazidime (4th gen. cephalosporin, NOT 3rd)
26
What pathogen responds well to steroids?
S. pneumoniae
27
What is the vector for Lyme disease?
Ixodes tick
28
What is the first line drug for Lyme Disease?
Doxycycline
*Alternative is amoxicillin
29
What is the initial treatment for Cryptococcal meningitis?
1) Amphotericin B or fluconazole
2) Reduction ICP
30
What duration of symptoms is associated with chronic meningitis?
4 weeks
31
What is the most common cause of chronic meningitis?
Cryptococcus neoformans
32