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Nayla Foundations Exam 4 > Meningitis/Encephalitis > Flashcards

Meningitis/Encephalitis Flashcards

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1
Q

What are the ways an infection can reach the CNS

A

Invade the blood stream
Retrograde neuronal path
Direct contagious spread

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2
Q

What is encephalomeningitis

A

Inflammation of brain and spinal cord

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3
Q

What is encaphalitis

A

acute inflammation of the brain parenchyma causing abn function (AMS, sz, change in behavior or speech

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4
Q

What is the MCC of encephalitis

A

Virus (70%)

also bacteria and fungi

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5
Q

What is primary encephalitis

A

Virus is seen or cultured- (+) neuronal involvement

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6
Q

What is post infectious encephalitis

A

Virus is not present, there is demyelination- (-) neuronal involvement

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7
Q

Increased mortality occurs in patients who

A

have multiple comorbidities

extremes of ages

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8
Q

Who is high risk for viral encephalitis

A

traveling to endemic areas
Out doors
Not vaccinated
immunodeficient

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9
Q

What organisms are associated with viral encephalitis

A 
HSV
Arthropods (west nile, St. Louis) 
Rabies
HIV
Enterovirus
Measles
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10
Q

If bacterial, what can cause encephalitis

A 
B. burgdorferia
T. pallidum
Listeria
Strep 
Klebsiella
N. meningitidis
M. tuberculosis
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11
Q

Non-infectious causes of encephalitis are

A

Drugs
Autoimmune
Radiation
Paraneoplastic syndrome

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12
Q

How does encephalitis present

A

fever, *seizures, AMS, Focal neuro sx (paralysis, CN palsy, increased DTR)

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13
Q

What does encephalitis usually NOT present with

A

meningeal irritation (photophobia, nuchal rigidity)- unless it’s meningoencephalitis

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14
Q

What history points you in the direction of encephalitis

A 
recent travel (vectors) 
recent illness
season
outdoor activities
birth Hx HSV
Parotitis (mumps) 
hydrophobia (rabies)
zoster rash (HZV)
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15
Q

What will you see on Encephalitis PE

A

Papilledema
flaccid paralysis (WNV)
arthritis (lyme, SLE)
Diabetes insipidus, SIADH= no temp control
Retinitis (CMV, WNV, paraneoplastic syndrome)

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16
Q

What rashes are commonly found with encephalitis

A 
Vesicular eruption (HSV, VZV) 
Maculopapular rash (EBV) 
Malar rash (SLE) 
Petechial rash (meningococcus, rickettsia) 
Erythema migrans (lyme) 
Erythema nodosum (TB, histo, sarcoidosis) 
Erythema multiforme (HSV, EBV, Mycoplasma) 
Kaposi sarcoma (AIDS)
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17
Q

Describe rashes by location

A

mucus membrane= Herpes
Gumma= tertiary syphillis
Genital lesions= HSV

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18
Q

How do you diagnose Encephalitis

A

MRI > CT

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19
Q

Diagnostic pro-tip

A

start with CT w/con if pt is really sick (if high Cr, do non-con)
It is faster and you can r/o mass lesion
also must do this before LP can be done

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20
Q

What is a contraindication to LP

A

Mass lesion! (r/o with CT first)
Sx of increased ICP (papilledema, focal neuro Sx, decreased LOC)
Severe coagulopathy or on anticoags
Skin infection

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21
Q

What MRI findings indicate encephalitis

A

Herpes: temporal lobe
Post-infectious: demyelination present
+/- hypersensitivity in edematous areas

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22
Q

What should you analyze with LP

A

opening pressure
cell count (w/ diff), glucose, protein, culture, gram stain
PCR (HSV and enterovirus)
IgM (WNV)

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23
Q

What is Cushing’s Triad

A

Respiratory depression
Bradycardia
Hypertension

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24
Q

How do you preform an LP

A

Lying or sitting, in L3-L5
Draw 15-20 ml CSF (4 tubes) and send to lab FAST
Do not refrigerate (H influenza and N meningitidis will die)

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25
How long does cellular degradation last
ONE HOUR (must send quickly to lab
26
LP steps are
Measure CSF pressure, then draw 4 tubes | chem serology- microbio- hematology- special study
27
What does normal CSF look like
clear like water
28
When does it become turbid
WBC >200 RBC >400 gross body fluids RBC >6000 (GROSSLY BLOODY) bacteria/protein >150
29
What can cause leukocytosis in CSF
Bacterial meningitis vasculitis leukemic infiltrate traumatic tap
30
What does pink/red CSF indicate
Traumatic tap (blood clear by tube 3 SAH (stays uniformely bloody) ICH cerebral infarct
31
Viral Encephalitis CSF will look like this
``` Cloudy/straw colored Normal-increased OP Elevated white count Lymphocytes on differential 0 RBC (unless HSV) normal-increased protein normal glucose ```
32
What are other diagnostic tests you can get for Viral Encephalitis
``` CBC (eosinophilia, lymphocytosis) Peripheral bleed smear (malaria) Culture (bacterial? arbovirus?) IgG, IgM Ab (WNV has IgM) Electrolytes (SIADH) Sputum (TB) CXR (infx vs non-infx) Whole body PET/CT (malignancy) ```
33
What is the Gold Standard for viral encephalitis (but not really used)
Brain biopsy (it is invasive
34
What is your goal with viral encephalitis
ID the cause, consult infectious disease and neuro ASAP
35
How do you manage encephalitis
Stabilize (ET tbe, vent, circulatory support, electrolytes) Start Empiric Antivirals Treat offending agent **Isolate until cause is identified!
36
What can mimic a CNS infection
Tumor Med S/E AI Increased ICP
37
What do you want to prevent and manage with viral encephalitis
secondary bacterial infections DVT GI ulcers
38
How do you manage increased ICP
elevate head of bed 30-45 degrees Hyperventilate to PaCO2 30 +/- corticosteroids and Mannitol
39
What is empiric treatment for Viral encephalitis
Acyclovir (HSV, VZV) early, and refine when cultures come back
40
What is primary prevention for viral encephalitis
``` Avoid vectors (bug spray) Vaccines (MMR, polio, rabies, meningitis) ```
41
What is meningitis
inflammatory disease of leptomeninges around brain and spinal cord
42
What are some meningitis RF
``` Extremes of ages birth infection from mom immune/vaccine status exposure risk IVDU ```
43
What are meningitis symptoms
``` HA photophobia N/V fever neck stiffness ```
44
This means bacterial meningitis until proven otherwise
Headache + Fever
45
If not fatal, what are common outcomes of bacterial meningitis
Neuro sequelae brain damage hearing loss learning disability
46
What is viral meningitis
Aseptic; meningeal inflammation WITHOUT bacterial infection can be due to malignancy, fungal, or meds Self-limited disease course
47
What are symptoms of viral meningitis
All normal +/- URI sx, rash, diarrhea
48
What is the MCC of viral meningitis
Enterovirus (coxsackie, herpangia, polio)
49
What is HSV2 preceded by
genital lesions
50
What does mumps meningitis present with
Headache low grade fever mild nuchal rigidity Mumps parotitis
51
What does viral meningitis CSF look like
``` *Cloudy color normal-high pressure Elevated WBC Lymphocytes on differential 0 RBC *Elevated protein normal glucose (* are the only differences from viral encephalitis) ```
52
How does bacterial meningitis occur in adults
Hematogenous spread of bacteria adjacent infected structures penetrating injury
53
How does bacterial meningitis spread in neonates
Pathogens from birth canal** | also placenta or surroundings
54
What happens after the bacteria is acquired
``` Multiplies quickly (patients present w.in 24 hours) Bacteria in CSF cause inflammatory cascade--> cerebral edema and high ICP--> neuro damage and possibly death ```
55
What happens if bacterial meningitis is not treated
DEATH!! | This is an EMERGENCY
56
What are the causes of bacterial meningitis by age
Neonate: Group B Strep (agalactiae) Baby/child: Strep pneumo Teen: N. Meningitidis Adult: Strep Pneumo
57
When do pregnant women get tested for group B strep
35-37 weeks gestation | If (+), they get prophylactic abx during labor to protect baby
58
What are general bacterial meningitis symptoms
slow or rapid onset fever, meningismus, +/- AMS, severe HA, N/V, photophobia, back pain Neonates also: Irritable, poor feeding, floppy, high pitch cry, vomiting, lethargy
59
What are red flags in the history
``` Travel birth Hx recent infx vaccine exposure Hx drug allergies, recent abx ```
60
What do bacterial meningitis vitals show
Hypotension tachycardia tachypnea +/- fever, low O2, wide pulse pressure
61
What are skin Sx of bacterial meningitis
Non-blanching petechiae/purpura rash | Cold/clammy (shock)
62
What are some HEENT findings in bacterial meningitis
bulging fontanelles and head circumference | papilledema
63
What are some neuro findings in bacterial meningitis
Irritability | Kernigs and Brudzinski's
64
How do you manage bacterial meningitis
``` IV access (fluids) Cultures (2 diff sites at 2 diff times) Start Abx CBC w/ diff, CMP, coags +/- CT or LP (dont delay abx to do these if susp. bacterial meningitis) ```
65
What does strep pneumo antigen test detect
Presence of C polysaccharide cell wall antigen
66
What does bacterial meningitis CSF look like
``` Turbid yellow color Increased OP VERY elevated WBC Neutrophils on differential 0 RBC Very elevated protein Low glucose (bacteria eat the glucose and poop the protein) ```
67
What is emperic treatment for bacterial meningitis
Ceftriaxone/Cefotaxime (3 gen ceph) + Vancomycin | Also add Ampicillin if 50+
68
What is emperic Tx for bacterial meningitis if allergic to penicillin
Moxifloxacin + Vancomycin | If 50+ add Bactrim
69
What is supportive treatment for bacterial meningitis
Fluid management ICP control (hyperventilate, elevate bed, +/- glucocorticoid dexamethosone) +/- induced hypothermia
70
What bacteria yields the worse prognosis
N. Meningitidis (teens)
71
What are common neuro complications with bacterial meningitis
``` AMS increased ICP/edema Sz focal neuro deficit hearing loss ```
72
Who should have meningitis prophylaxis
>8 hours contact at closer than 3 feet | Direct exposure to oral secretions 7 days before Sx or 24 hours after Tx
73
How can you prevent bacterial meningitis
Vaccination against; - serogroup A, C, W, Y: Menactra 9 mo- 55 y/o OR Menveo 2 mo. to 55 y/o - Serogroup B: Trumenba 10-25 y/o OR Bexsero 10-25 y/o
74
When is meningococcal B (MenB) vaccine given
10+ with persistent asplenia working with N. Meningitidis High risk

Nayla Foundations Exam 4 (15 decks)

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