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Hailey - Neuro > Meningitis/Encephalitis > Flashcards

Meningitis/Encephalitis Flashcards

(48 cards)

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1
Q

listeria mortality rate

A

25%

gram + rod (positive purple listeria)

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2
Q

listeria empiric Tx

definitive Tx

A

ceftrixone and ampicillin

definitive: ampicillin and gentamicin
Gentlemen get amped up on Listerine.

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3
Q

most common cause VIRAL M&E in summer/fall

A

enterovirus

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4
Q

cell wall inhibitors mech (general)

A

inhibit transpeptidation of peptidoglycan (inhibit cell wall* synthesis)

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5
Q

Listeria monocytogenes
gram ___
big 3 and ___
virulence

A

gram + rod (purple positive listerine)
big 3 and nuchal rigidity and diarrhea from soft cheese, deli, etc.

internalin induces phagocytosis
phospholipase and listeriolysin O allow escape
actin tail

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6
Q

if focal mass lesion, labs

A

no LP – increased risk of brain herniation = BAD

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7
Q

risks with 3rd generation cephalosporin: ceftriaxone

A

increased risk of neurotoxic side effects

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8
Q

Why treat empirically with ceftriaxone?

A 
bactericidal
small 
lipophilic
can cross BBB
not a ligand for efflux pumps
streptococci +
serious gram -
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9
Q

most aggressive empiric treatment combo

A

ceftriaxone
vancomycin
acyclovir
dexamethasone

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10
Q

encephalitis vs encephalopathy

A

encephalitis: infection (fever, headache, focal neuro signals, seizures)
encephalopathy: diffuse cerebral dysfunction WITHOUT inflammation, usually due to toxin or metabolic dysfunction

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11
Q 
where's waldo: 
meningitis
encephalitis
abscess
myelitis
A

m: subarachnoid space
e: diffuse parenchyma
a: focal parenchyma
my: spinal cord

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12
Q

etiology of encephalitis

A 
33-66% unknown
then viral (entero, adeno, herpes, rabies)
also nonviral (ricketssia, mycoplamsa, ADEM)
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13
Q

STAT TO DO with CNS infection

A
  1. H and P*
  2. blood culture*
  3. start abx*
  4. neuroimaging*
  5. LP/biopsy
  6. ID organism (gram stain/PCR/RT-PCR)
  7. switch to definitive Tx
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14
Q

BM labs

A 
increased pressure
increased WBC
>80% PMNs
elevated protein
decreased glucose
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15
Q

VM labs

A 
mod WBC count
>50% Ls
<20% PMNs
mod protein
normal glucose
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16
Q

FM labs

A 
increased pressure
m100 WBC
>50% Lymphocytes
mod elevated prto
normal glucose
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17
Q

Aseptic meningitis

A

> 85% VIRAL: enterovirus/picornavirus, HSV2, arthropod, HIV
highest incidence within 12mo old

Sx: fever, HA, photophobia, dec nuchal rigidity, change mental status

CSF: increased Lymphocytes and PMNs, mod inc protein, normal glucose

Tx: supportive therapy
can be fatal in neonatal period

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18
Q

Septic meningitis

A

BACTERIAL: streptococcus pneumonia+ lancet (adults), neisseria meningitides - diplococci (teen/college), homophiles influenza type B - pleomorphic (babies, w/ no vaccine)

Sx: fever, nuchal rigidity, iritability, neuro dysfxn

CSF: inc PMNs, inc protein, dec glucose

LIFE THREATENING, PROMPT EMPIRIC TX
ceftriaxone, vanco (MRSA), acyclovir (HSV2), cefeprime (psuedomonas), ampicillin (listeria)

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19
Q

Chronic meningitis

A

SPIROCHETES - treponema pallidum/syphilis, borrelia burgdorfori
MYOCBACTERIUM TUBERCULOIS (india ink*)
FUNGI - cryptococcus neoformances, coccoides, candida albicans
IMMUNOCOMPROMISED

Tx: 4 drugs RIPE
Ri
Isoniazid
P
E
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20
Q

TORCH infections (perinatal)

Study These Flashcards
A 
Toxoplasma
Other: syphilis, VZV, parvovirus B19, group B strep, e. coli
Rubella (german measles)
CMV cytomegalovirus
HSV-2/HIV
21
Q

HSV associated with

Study These Flashcards
A

temporal lobe (would see on MRI)

22
Q

BM gross

Study These Flashcards
A

PURULENT/PUS

particularly dense over engorged blood vessels

23
Q

VM gross

Study These Flashcards
A

swollen, or look normal (no pus/exudate)

24
Q

BM micro

Study These Flashcards
A

NEUTROPHILS inside vessels = phlebitis, into brain tissue = cerebrates
FIBRIN in exudate: healing stage in exudate > BAD = disrupts absorption of CSF > hydrocephalus

25
VM micro
lymphocytic infilatrion, mild | mononuclear: round, dark cell
26
mycobacterium tuberculosis
``` more chronic fashion acid fast basal exudate that obliterates cisterns (interferes with cistern magnum and CNs) exudate more GELATINOUS/CREAMY ADHESIONS/STRINGY MONONUCLEAR CELLS GRANULOMAS: obliterative endarteritis caseating hisitocytes ```
27
pathology of acute inflammation
neutrophils vessels larger and leakeir "busy" mickey mouse nuclei abscess: neutrophils stick around circumscribed collection of pus, GREEN NEUTROPHIL EXUDATE chronic: mononuclear cells, more uniform than "busy"
28
gliosis
astryocyte rxn to injury
29
migroglial cells
proliferate around single neuron dying off, around areas of necrosis
30
hydrocephalus from meninigitis...how
if healing blocked ventricles = communicating = all vent sys involved
31
CNS infections
Meningitis: Neiserria, strep pneu, h influ, fungal Encephalitis: viral (herpes) Abscess: strep, staph
32
abscess
``` mix of bacteria: strep pseudomonas haemophilus staph bacteroides ```
33
enterovirus
single stranded + sense RNA capsid no envelope
34
transmission/development
muscosal colonization > invasion and multiplication in bloodstream > cross BBB > in CSF > release inflammatory cytokines in CSF by astrocytes and microglia > increased perm BBB > diapedesis of leukocytes > edema > inc ICP > HA > neuronal injury
35
virulence factors
``` capsule IMPT IgA protease Pili help attach to mucosa endotoxin (by gram -) outer membrane proteins ```
36
Neisseria meningitides virulence special
LOS: looks like brain sphinoglipids, so is recognized as self skin rash transmitted through respiratory droplets
37
H flu type B special because
B capsular polysaccharide help facilitate its invasion into the brain CHOCOLATE AGAR
38
Mycobacterium tuberculosis special because
ACID FAST bacilli stain | RIPE Tx
39
RIPE Tx
Rifampin - inhibits dDNA RNA pol, inhibits cypP450 Isoniazid - inhibits mycolic acids Ethambutol - inhibits cell wall synthesis by binding arabinysyl transferase Pyrazinamide
40
cryptococcus neoformans special because
INDIA INK STAIN inhaled as spores, like yeast in IC fluconazole 4 lyfe
41
site of herpes latency
NEURON
42
herpes viruses are Baltimore class
Class I | ds DNA
43
VZV most comomon cause of encephalitis among
IC patients | particularly if have HIV/AIDS or stem cell transplantation
44
only alpha herpes virus produce
thymidine kinase | so can use acyclovir
45
acyclovir
DNA polymerase chain inhibitor, stops new DNA made, dGTP switched out
46
Tx betaherpesviruses
gancyclovir
47
post-infectious encephalitis
ADEM acute disseminated encephalomyelitis MOST COMMON inflammatory demyelinating condition, monophasic, pediatric usually, days to weeks post-inf also APME acute disseminated encephalomyelitis (demyelination, M and S defects) SSPE subacute sclerosing panencepthalitis MOST SCARY
48
measles virus
Class V, ssRNA - | enveloped

Hailey - Neuro (10 decks)

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