Infectious Diseases of the Nervous System Flashcards Preview

Neuro Pt 2 > Infectious Diseases of the Nervous System > Flashcards

Flashcards in Infectious Diseases of the Nervous System Deck (23)
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1
Q

Symptoms of meningitis

A

Classic Triad: Only ~45% of patients have the complete classic triad of fever, headache, and neck stiffness (nuchal rigidity/meningismus), but nearly 100% of patients have at least 2 of 4 symptoms (fever, headache, nuchal rigidity, altered mental status).

2
Q

Parthenogenesis of bacterial meningitis

A

Bacteria reaches the subarachnoid space from the bloodstream (most common), adjacent intracranial infection (sinusitis, mastoiditis, otitis), congenital, traumatic or surgical defects in skull/spinal column

Bacterial cell wall components stimulate pro-inflammatory cytokines (e.g. TNF, IL-1), increase BBB permeability, and recruit neutrophils (PMNs). PMNs add to purulent exudates, and enhance cytotoxic edema via reactive oxygen species

3
Q

Diagnosis of bacterial meningitis

A
  1. Lumbar Puncture
  2. Blood cultures
  3. Neuroimaging
4
Q

Indications to wait to do a LP in a suspected case of bacterial meningitis

A
  1. decreased level of consciousness
  2. focal neurologic deficits
  3. papilloedema
  4. new onset seizures
  5. History of CNS disease or an associated condition (e.g. frontal sinusitis) that increases probability of brain abscess/empyema.
  6. Immunocompromised
  7. If above criteria are absent >97% have a normal CT.
5
Q

Most common organism in bacterial meningitis in neonates

A

Group B Strep

6
Q

Most common organism in bacterial meningitis in ages 2-23 months

A

S. Pneumo

7
Q

Most common organism in bacterial meningitis in ages 2-35 years old

A

Neisseria meningitidis
and
S. Pneumo

8
Q

Most common organism in bacterial meningitis in pts older than 35 years old

A

S. Pneumo

9
Q

What organism causes meningitis in 25% of cases involving pts over the age of 60 or immunocompromised?

A

Listeria monocytogenes

10
Q

CSF profile in bacterial meningitis

A

WBCs: High
Lots of PMNs
Glucose: low
Protein: High

11
Q

CSF profile in viral meningitis

A

WBCs: High (but not as high as bacterial)
Lots of lymphocytes
Glucose: Normal
Protein: Normal or slightly elevated

12
Q

Treatment of suspected bacterial meningitis in neonates

A

Ampicillin
+
Cefotaxime

13
Q

Treatment of suspected bacterial meningitis in children and adults

A

Ceftriaxone or Cefotaxime
+
Vanco

14
Q

Treatment of suspected bacterial meningitis in adults >50

A
Ceftriaxone or Cefotaxime 
\+ 
Vanco
\+
Ampicillin
15
Q

Corticosteroid administration in cases of suspected meningitis

A

Give before or at same time as 1st antibiotic

16
Q

Common causes of viral meningitis

A

Enterovirus
HSV2
Arboviruses

17
Q

Symptoms of viral meningitis

A

Headache, fever, meningeal irritation

Milder than bacterial

18
Q

Diagnosis of viral meningitis

A
  1. CSF analysis
  2. PCR
  3. IgM if WNV
19
Q

Viral encephalitis

A

Viral encephalitis is an infection of brain tissue rather than just subarachnoid space (meningitis). Signs/symptoms usually much more extensive than for meningitis.

20
Q

Clinical symptoms of viral encephalitis

A

A. Common: Altered consciousness, fever, and headache.
B. Seizures and focal neurological signs/symptoms are common: personality change, alteration in mental status/level of consciousness (75-95%), aphasia (65-75%), hemiparesis (30-40%), ataxia (40%), cranial nerve palsies (30-35%), and visual field loss (10-15%).(% shown is for HSV encephalitis). Tremors, myoclonus, Parkinsonism seen in WNV.

21
Q

Most common causes of viral encephalitis

A

Arboviruses and HSV

22
Q

What is the goal when a pt walks in the door with suspected bacterial meningitis

A

Start Antibiotics within 60 minutes of patient arrival in the emergency room

Get blood cultures

Start corticosteroids

23
Q

What to start immediately in suspected cases of viral encephalopathy?

A

Acyclovir