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CMT > Meningitis & Encephalitis > Flashcards

Meningitis & Encephalitis Flashcards

1
Q

Meningitis

inflammation of which spaces

A
  • pia mater
  • arachnoid
  • CSF filled subarachnoid space
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2
Q

Meningitis

which age has majority of cases? why?

A
  • adults
  • vaccination
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3
Q

Meningitis

common bacterial organisms causing meningitis

5

A
  1. strep pneumoniae
  2. neisseria meningitidis
  3. Group B strep
  4. H. flu
  5. Listeria
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4
Q

Meningitis

sx in Bacterial Meningitis

6

A
  • Fever
  • HA
  • Nuchal Rigidity
  • AMS (altered mental status, confusion, lethargy)
  • photophobia
  • n/v
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5
Q

Meningitis

PE Findings

7

A
  • Fever
  • pos Kernig and Brudzinski
  • Nuchal Rigidity
  • Seizures
  • Focal Neuro Deficits (CN VI, III, IV, VIII)
  • Papilledema (rare)
  • skin rashes
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6
Q

Meningitis

describe Kernig Sign

A
  • flexing knee causes pain
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7
Q

Meningitis

describe Brudzinski sign

A

lifting head causes knee flexion w/ pain

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8
Q

Meningitis

describe CN III palsy

A

lateral, downward deviation
w/ ptosis

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9
Q

Meningitis

describe CN IV Palsy

A

upward deviation

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10
Q

Meningitis

CN VI palsy

A

medial deviation

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11
Q

Meningitis

essentials of dx

5 components

A
  1. fever, HA, v, delirium, seizures
  2. rash on skin/mucous membranes
  3. neck/back stiffness
  4. pos Kernig, Brudzinski
  5. purulent spinal fluid
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12
Q

Meningitis

dx

A
  • Head CT before LP
  • culture of cerebrospinal fluid
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13
Q

Meningitis

bacterial vs viral meningitis

A

bacterial more probable if:
* glucose < 34
* protein > 220
* WBC > 2000
* Neutrophil > 1180

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14
Q

Meningitis

what would gram positive diplococci in CSF suggest?

A

pneumococcal

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15
Q

Meningitis

what would gram negative diplococci in CSF suggest?

A

meningococceal

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16
Q

Meningitis

what would gram negative coccobacilli in CSF suggest?

A

H. flu

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17
Q

Meningitis

what do gram pos rods suggest?

A

listeria

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18
Q

Meningitis

what do gram pos cocci in pairs and short chains in CSF suggest?

A

GBS

19
Q

Meningitis

Labs for Dx bacterial meningitis

7

A
  • CMP
  • CBC
  • PT/PTT
  • Lactic Acid
  • STI Panel (HIV/Syphilis included)
  • Blood Cultures
  • UA
20
Q

Meningitis

imaging to dx bacterial meningitis

A

CXR

21
Q

Meningitis

Bacterial Meningitis Tx

A
  • emperic: cephalosporin w/ vanco
  • steroids: dexamethasone
  • ceftriaxone to clear NP carrying
22
Q

Meningitis

what to add to tx if suspecting…
* listeria
* HSV
* Rocky Mountain Spotted Fever

A
  • ampicillin
  • acyclovir
  • doxy
23
Q

Meningitis

describe aseptic meningitis

A
  • clinical and lab evidence for meningeal inflammation w/ mononuclear pleocytosis w/ negative gram stain, neg bacterial cultures
24
Q

Meningitis

causes of aseptic meningitis

6

A
  • viral
  • bacterial
  • fungal
  • medications
  • malignancies
  • autoimmunity
25
Q

Meningitis

what is viral meningitis likely caused by?

7

A
  1. enterovirus
  2. HSV
  3. HIV
  4. WNV
  5. VZV
  6. Mumps
  7. CMV
26
Q

Meningitis

describe enterovirus meningitis

3 components

A
  • most common cause
  • rash, sore throat, diarrhea, joint ache, HA
  • CSF: PMNs predominate early, repeat LP will show evolution to lymphocytic predominance
27
Q

Meningitis

describe HSV meningitis

4 components

A
  • high CSF RBC count
  • HA, photophobia, stiff neck, neurologic complications
  • Tx: acyclovir IV
  • high mortality rate
28
Q

Meningitis

predisposing factors for cryptococcosis meningitis

A
  • chemo
  • Hodgkin lymphoma
  • corticosteroid therapy
  • structural lung diseases
  • transplant recipients
  • TNF alpha inhibitor therapies
  • AIDS
29
Q

Meningitis

sx of cryptococcosis meningitis

A
  • HA
  • AMS
  • meningismus
30
Q

Meningitis

cryptococcosis meningitis CSF findings

A

demonstration of capsular polysaccharide antigen or pos culture

31
Q

Meningitis

non-infectious causes of asepctic meningitis

4 categories

A
  1. malignancies
  2. systemic processes
  3. inflammatory
  4. drug hypersensitivity
32
Q

Meningitis

drug induced meningitis likely due to

5

A
  • NSAIDs
  • Abx
  • IV immune globulin
  • chemo drugs
  • anti-epileptics
33
Q

Meningitis

pathophys

A
  • delayed hypersensitivity rxn or direct meningeal irritation
34
Q

Meningitis

PE findings Aseptic Meningitis

5

A
  • maculopapular exanthem (HIV/Syph)
  • parotitis (mumps)
  • vesicular and ulcerative gential lesions (HSV)
  • Oropharyngeal thrush/cervical LAD (HIV)
  • asymmetric flaccid paralysis (WNV)
35
Q

Meningitis

aseptic meningitis CSF findings

A
  • high lymphocytes
  • high protein
  • normal glucose, neg gram stain
36
Q

Meningitis

prevention

A
  • vaccination
  • PEP
37
Q

differentiate encephalitis vs meningitis

A
  • Encephalitis: abnormalities in brain function, AMS, motor/sensory deficits, altered behavioral/personality changes, speech, movement disorders
  • Meningitis: uncomfortable, lethargic, distracted by HA, cerebral function remains normal
38
Q

Encephalitis

etiology (viral)

9

A
  • HSV
  • VZV
  • EBV
  • measles
  • mumps
  • rubella
  • rabies
  • CMV
  • arboviruses
39
Q

Encephalitis

presentation

A
  • viral prodrome (fever, malaise, myalgia, HA, etc)
  • signs/sx of causative agent
  • AMS from subtle deficits to complete unresponsiveness
  • seizures common
  • papilledema rare
  • focal neurologic abnormalities (hemiparesis, aphasia, CN palsies)
40
Q

Encephalitis

imaging

A
  • MRI sensitive for demyelination, edema, necrosis, inflammation
  • Head CT w/ or w/out contrast if suspecting space occupying lesions, brain abscesses
41
Q

Encephalitis

what does temporal lobe involvement suggest

A

HSV encephalitis

42
Q

Encephalitis

LP findings

6

A
  • PCR pos for viral cause
  • RBCs suggest HSV-1
  • normal glucose
  • increased WBCs
  • elevated protein
  • elevated opening pressure
43
Q

Encephalitis

Tx

A
  • causative agent rarely identified, but tx of underlying cause if found
  • important to r/o HSV (if suspected, ASAP acyclovir)
  • corticosteroids

CMT (72 decks)

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