Falkenberg: CNS Infections Flashcards
(23 cards)
How do most bugs get into the CNS?
hematogenous/venous spread
i.e. abcess, respiratory, GI/GU, pericranial sites like sinuses and middle ear
**less common: penetrating trauma
What is meningitis vs encephalitis vs myelitis?
meningitis: infection of meninges
encephalitis: infection of brain
myelitis: infection of spinal cord
CNS infections are emergencies, b/c the brain is enclosed. What can increased intracranial pressure lead to if left untreated?
herniation of brain and necrosis
Infection of the CNS can also lead to (blank) throughout the body
sepsis
What are these signs and symptoms of?
headache nausea and vomiting fever meningismus altered consciousness
acute bacterial meningitis
What should you do for children who are less than 28d/0 w a fever greater than 100.6?
full septic work-up including lumbar puncture
Should you do a lumbar puncture in an infant if you suspect bacterial meningitis?
yes!
Causes of bacterial meningitis?
S. pneumoniae H. influenzae L. monocytogenes Group B streptococcus N. meningitidis
How to diagnose meningitis?
H&P
CT of head to rule out space occupying lesion
lumbar puncture
blood cultures *can be systemic and spread to the blood
What are some differences in CSF in bacterial vs viral infections?
bacterial: pressure >30, turbid appearance, protein >1g/L, PMN, gram stain positive
viral: normal to slightly increased pressure, clear appearance, <1g/L protein, monocytes
Treatment for meningitis?
antibiotics *that cross the BBB
hospitalization
steroids *to help w inflammation
supportive care
What are these symptoms of?
headache
fever
viral syndrome *feeling of malaise
meningismus
viral meningitis
**not as sick as pt w bacterial meningitis
What are the causes of viral meningitis?
enteroviruses
Treatment for viral meningitis?
Usu resolves in 7-10 days, so let it be. Can use some antivirals.
What are these symptoms of?
*confusion
*personality change
altered mental status
fever
seizures
encephalitis
**these symptoms make sense, b/c the brain is involved, not just the meninges
Causes of encephalitis?
herpes simplex virus varicella zoster virus HIV Rabies virus etc
**seen often in immunosuppresed disorders
How to diagnose encephalitis?
H&P Brain image to rule out space occupying lesion lumbar puncture culture of CSF antibody titers **PCR of CSF for Herpes Encephalitis
What are these signs & symptoms of?
headache *focal neurologic deficits *fever, chills and other signs of infection usu do not occur papilledema nausea, vomiting
brain abscesses
What are treatment options for a brain abscess?
antibiotics
surgical drainage
When to do a lumbar puncture?
suspected cases of meningitis & encephalitis
if severe headaches, MS, subarachnoid hemmorrhage
can also be used as a treatment if pt has increased ICP or pseudotumor cerebri
What are some complications of lumbar punctures?
spinal headache
nerve damage
back pain
infection or bleeding *rare
When NOT to do a lumbar puncture?
pt refuses
skin infection or abscess
bleeding disorder
space occupying lesion
Both bacterial and viral meningitis have these symptoms
fever
headache
meningismus
