Term
| What is the most common presenting symptom of meningitis? |
|
Definition
|
|
Term
| What is the function of the meninges? |
|
Definition
| keeps the CNS protected and lubricated |
|
|
Term
| What things can cause meningitis? |
|
Definition
bacteria
mycobacteria and fungi
spirochetes
viruses
protozoa |
|
|
Term
| What causes chemical meningitis? |
|
Definition
| blood irritating the meninges |
|
|
Term
| What are the major components of meningitis diagnosis? |
|
Definition
history and PE
blood count and culture
LP for CSF evaluation
latex agglutination test (rarely used except for Cryptococcus)
PCR test of CSF (good, but takes too long to be helpful) |
|
|
Term
| When is a latex agglutination test used in the diagnosis of meningitis? |
|
Definition
|
|
Term
| What things are evaluated in the CSF for meningitis? |
|
Definition
cell count
glucose
protein
gram stain
+/- acid fast eval
culture |
|
|
Term
| What are the signs and symptoms of meningitis? |
|
Definition
headache, fever, sensory disturbances, neck/back stiffness
+ Kernig sign, + Brudzinski sign
CSF abnormalities |
|
|
Term
| What is the classic triad associated with meningitis? |
|
Definition
fever
stiff neck
altered mental status |
|
|
Term
| What is a positive Brudzinski sign? |
|
Definition
| passive flexion of the neck causes flexion of the legs |
|
|
Term
| What is a positive Kernig sign? |
|
Definition
| extension of the knee while the hip is flexed produces pain and resistance |
|
|
Term
| What test is absolutely necessary for adequate evaluation of patients with meningitis? |
|
Definition
|
|
Term
| What should you check for in the eyes of a patient suspected to have meningitis? |
|
Definition
| papilledema (sign of increased intracranial pressure) |
|
|
Term
| What test would you order to check for a space occupying lesion? |
|
Definition
|
|
Term
| What 2 things do you need to get before doing an LP? |
|
Definition
check for papilledema
CT to look for space occupying lesion |
|
|
Term
| What conditions is a LP contraindicated in? |
|
Definition
those with increased intracranial pressure
brain abscess, subdural hematoma, subdural empyema, necrotic temporal lobe from herpes encephalitis |
|
|
Term
| Why is a LP contraindicated in conditions that cause increased intracranial pressure? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the blood count level with bacterial meningitis? |
|
Definition
|
|
Term
| What is the glucose level with bacterial meningitis? |
|
Definition
|
|
Term
| What is the protein level with bacterial meningitis? |
|
Definition
|
|
Term
| What is the ICP level with bacterial meningitis? |
|
Definition
|
|
Term
| What is the blood count level with mycobacteria/fungal meningitis? |
|
Definition
|
|
Term
| What is the glucose level with mycobacteria/fungal meningitis? |
|
Definition
|
|
Term
| What is the protein level with mycobacteria/fungal meningitis? |
|
Definition
|
|
Term
| What is the ICP level with mycobacteria/fungal meningitis? |
|
Definition
|
|
Term
| What is the blood count level with spirochetal meningitis? |
|
Definition
|
|
Term
| What is the glucose level with spirochetal meningitis? |
|
Definition
|
|
Term
| What is the ICP level with spirochetal meningitis? |
|
Definition
|
|
Term
| What is the protein level with spirochetal meningitis? |
|
Definition
|
|
Term
| What is the blood count level with aseptic/viral meningitis? |
|
Definition
|
|
Term
| What is the glucose level with aseptic/viral meningitis? |
|
Definition
|
|
Term
| What is the protein level with aseptic/viral meningitis? |
|
Definition
|
|
Term
| What is the ICP level with aseptic/viral meningitis? |
|
Definition
|
|
Term
| What should you do immediately when you suspect meningitis? |
|
Definition
| start empiric antibiotic treatment while you continue the workup (get blood cultures first and do LP within 4 hours! |
|
|
Term
| If you decide to start empiric antibiotic treatment for suspected meningitis, what do you need to make sure to get before? |
|
Definition
blood cultures before
LP at least within 4 hours of starting |
|
|
Term
| What should you add to the first dose of antibiotics to help decrease ICP? |
|
Definition
|
|
Term
| What are the treatments for increased ICP? |
|
Definition
hyperventilation
mannitol
dexamethasone
drainage of CSF (ventricular catheter, repeated LP--be leary of this) |
|
|
Term
| What are predisposing factors of bacterial meningitis? |
|
Definition
respiratory infection
otitis media
mastoiditis
head trauma
hemoglobinopathy
HIV
other immune deficiency states |
|
|
Term
| The emergence of what bacteria has resulted in new challenges in treating bacterial meningitis? |
|
Definition
| penicillin-resistant Strep pneumoniae |
|
|
Term
| Why is bacterial meningitis during the neonatal period considered separately? |
|
Definition
| has unique epidemiologic and etiologic features |
|
|
Term
| What is the pathophysiology behind bacterial meningitis? |
|
Definition
bacteria reach the subarachnoid space by a hematogenous route, and infection often localizes to other organs
bacteria may reach the meninges directly in patients with a parameningeal focus of infection |
|
|
Term
| What things play critical roles in triggering the inflammatory response and ensuing neurologic damage associated with bacterial meningitis? |
|
Definition
interleukin-1 (IL-1)
tumor necrosis factor-alpha (TNF-alpha)
enhanced NO production |
|
|
Term
| What results from the bacterial meningitis infection and inflammatory response on penetrating cortical vessels? |
|
Definition
swelling and proliferation of the endothelial cells of arterioles
similar process can involve the veins, causing mural thrombi and obstruction of flow
result is an increase in intracellular sodium and water leading to edema and increased ICP |
|
|
Term
| What does brain edema result in? |
|
Definition
| increased ICP and possibly uncal herniation |
|
|
Term
| What endocrine abnormality is found in most patients with meningitis? |
|
Definition
|
|
Term
| What factors contribute to the development of focal or generalized seizures with bacterial meningitis? |
|
Definition
increased intracellular sodium
increased ICP
SIADH (furthers water retention) |
|
|
Term
| Severe brain edema also results in _________ _______, leading to ________. |
|
Definition
|
|
Term
| How do the intracranial changes associated with bacterial meningitis manifest clinically? |
|
Definition
| alteration of consciousness and postural reflexes |
|
|
Term
| What does caudal displacement of the brainstem cause? |
|
Definition
|
|
Term
| What can happen if the intracranial changes associated with bacterial meningitis are not treated? |
|
Definition
decortication or decerebration
can progress rapidly to respiratory and cardiac arrest |
|
|
Term
| How is Neisseria meningitidis contracted? |
|
Definition
|
|
Term
| What has led to a large decrease in the number of bacterial meningitis cases in the US? |
|
Definition
| conjugate H. infleunzae type b vaccine |
|
|
Term
| What is the incidence rate for bacterial meningitis caused by N. meningitidis in children aged 1-23 months? |
|
Definition
|
|
Term
| What is the risk of secondary cases of bacterial meningitis for family contacts? |
|
Definition
|
|
Term
| What is the risk of secondary cases of bacterial meningitis for daycare contacts? |
|
Definition
|
|
Term
| What is the rate of Strep pneumoniae meningitis in children aged 1-23 months? |
|
Definition
|
|
Term
| What is the pathogenesis of neonatal meningitis? |
|
Definition
| bacteria from the maternal genital tract easily infect the infant after membrane rupture |
|
|
Term
| What bacteria can reach the fetus transplacentally and cause neonatal meningitis? |
|
Definition
group B strep
enteric gram negative rods
Listeria monocytogenes |
|
|
Term
| What is the incidence rate of neonatal bacterial meningitis? |
|
Definition
| 0.25-1 case per 1000 live births |
|
|
Term
| What type of birth puts the infant at higher risk of getting neonatal bacterial meningitis? |
|
Definition
|
|
Term
| Approximately ____% of newborns with clinical sepsis have associated bacterial meningitis? |
|
Definition
|
|
Term
| What age group has the highest mortality rate with bacterial meningitis? |
|
Definition
neonates
mortality rates are highest during first year of life, decrease in midlife, and increase again in the elderly |
|
|
Term
| Most patients with bacterial meningitis are children under ___, and 70% of cases occur in children under ____. |
|
Definition
|
|
Term
| Symptoms of neonatal meningitis are __________. |
|
Definition
|
|
Term
| What are the symptoms of neonatal meningitis? |
|
Definition
poor feeding
lethargy
irritability
apnea
lislessness
apathy
fever
hypothermia
seizures
jaundice
bulging fontanelle
pallor
shock
hypotonia
shrill cry
hypoglycemia
intractable metabolic acidosis |
|
|
Term
| What is the major difference between neonatal bacterial meningitis and normal bacterial meningitis? |
|
Definition
neonatal rarely presents with cardinal signs of meningitis (fever, vomiting, stiff neck)
these symptoms are the exception rather than the rule with neonatal meningitis |
|
|
Term
| What are the predominant pathogens in neonatal bacterial meningitis? |
|
Definition
group B strep
gram negative enteric flora |
|
|
Term
| What pathogens are more common in premature newborns with neonatal meningitis? |
|
Definition
Staph epidermidis
Candida
due to the fact that these pts. receive multiple antibiotics, hyperalimentation, and undergo various srugical procedures |
|
|
Term
| What is a well known but fairly uncommon etiologic pathogen of neonatal meningitis? |
|
Definition
|
|
Term
| What symptoms are associated with bacterial meningitis in children and adults? |
|
Definition
nuchal rigidity
opisthotonos
bulging fontanelle
convulsions
photophobiaheadache
alterations of the sensorium
irritability
lethargy
anorexia
nausea
vomiting
coma
fever (not always) |
|
|
Term
|
Definition
| state of severe hyperextension and spasticity in which an individual's head, neck, and spinal column enter into a complete bridging or arching position |
|
|
Term
| Opisthotonos is an ___________ effect caused by spasm of the axial muscles along the spinal column. |
|
Definition
|
|
Term
| What are helpful indicators of bacterial meningitis but may be absent in the very young, debilitated, or malnourished infants? |
|
Definition
| Kernig and Brudzinski signs |
|
|
Term
| What skin findings are associated with bacterial meningitis in infants and children? |
|
Definition
| range from nonspecific blanching, erythematous, maculopapular rash to full-blown petechial or purpuric rash |
|
|
Term
| What does the presence of focal neurologic signs predict with bacterial meningitis? |
|
Definition
| complicated hospital course and significant long-term sequelae |
|
|
Term
| Seizures that occur during the first ___ days of illness with bacterial meningitis usually have little prognostic significance. |
|
Definition
|
|
Term
| What seizures are predictors of a complicated hospital course with serious sequeale with bacterial meningitis? |
|
Definition
prolonged or difficult-to-control
especially when observed after 4th hospital day |
|
|
Term
| What indicates a significant collection of fluid in the subdural space with bacterial meningitis? |
|
Definition
| focal CNS symptoms and other systemic signs (ex. fever) |
|
|
Term
| Incidence of subdural effusion is __________ of the bacterial organism causing meningitis? |
|
Definition
|
|
Term
| What signs are indicative of a poor prognosis and affect approximately 6% of infants and children with bacterial meningitis? |
|
Definition
|
|
Term
| What are the most common etiologic agents of bacterial meningitis in children older than 4 weeks? |
|
Definition
Strep pneumoniae
N. meningitidis |
|
|
Term
| What used to be the most common pathogen of bacterial meningitis? |
|
Definition
| H. influenzae (essentially disappeared in countries where conjugate vaccine is routinely used) |
|
|
Term
| What is the leading cause of bacterial meningitis? |
|
Definition
| Strep pneumoniae (lacet-shaped, gram positive diplococci) |
|
|
Term
| What serotypes of S. pneumoniae are most often associated with bacteremia and meningitis? |
|
Definition
|
|
Term
| What is the drug of choice for broad spectrum antibiotic treatment? |
|
Definition
|
|
Term
| Penicillin-resistant pneumococci often demonstrate resistance to what antibiotics? |
|
Definition
sulfamethoxazole/trimethoprim (Bactrim)
tetracyclines
chloramphenicol
macrolides |
|
|
Term
| What class of antibiotics has been shown to be effective against some penicillin-resistant strains of pneumococci? |
|
Definition
| 3rd generation cephalosporins (cefotaxime, ceftriaxone) |
|
|
Term
| What antibiotics are effective for all isolates of Strep pneumoniae? |
|
Definition
vancomycin
various oxazolidinones |
|
|
Term
| What antibiotics are contraindicated in children but have have excellent activity against most pneumococci and achieve adequate CNS penetration? |
|
Definition
| fluoroquinolones (levofloxacin, trovafloxacin) |
|
|
Term
| Describe N. meningitidis. |
|
Definition
gram negative, kidney bean-shaped
frequently found intracellularly |
|
|
Term
| What pathogen of bacterial meningitis is commonly found in the upper respiratory tract and is transmitted person-to-person by direct contact through infected droplets, often from asymptomatic carriers? |
|
Definition
|
|
Term
| What age group is most commonly affected by N. meningitidis meningitis? |
|
Definition
|
|
Term
| What is often seen with N. meningitidis meningitis? |
|
Definition
| petechial or purpuric rash |
|
|
Term
| What type of meningitis has normocellular CSF been reported in? |
|
Definition
|
|
Term
| Most deaths occur within ____ hours of hospital admission in patients who have features associated with poor prognosis with meningococcal meningitis. |
|
Definition
|
|
Term
| What are features associated with poor prognosis in meningococcal meningitis? |
|
Definition
hypotension
shock
neutropenia
extremes of ages
petechia and purpura of <12hrs duration
CID
acidosis
presence of organism in WBC
low ESR or CRP
serogroup C disease |
|
|
Term
|
Definition
| pleomorphic gram negative rod |
|
|
Term
| Who does H. influenzae meningitis occur in? |
|
Definition
| children who have not been immunized (most cases are age 1 month to 3 years) |
|
|
Term
| Why is H. influenzae meningitis uncommon after age 3? |
|
Definition
| significant number of non-immunized children acquire antibodies against the capsular polyriophosphate of H. influenzae type b, which are protective |
|
|
Term
| Who does L. monocytogenes meningitis affect? |
|
Definition
newborns
immunocompromised children and adults
adults over the age of 50 |
|
|
Term
| What bacterial meningitis has been associated with the consumption of contaminated foods (milk, cheese)? |
|
Definition
|
|
Term
| When can a firm diagnosis of bacterial meningitis be made? |
|
Definition
bacteria isolated from CSF
evidence of meningeal inflammation |
|
|
Term
| What other lab findings are highly suggestive of bacterial meningitis? |
|
Definition
| bacterial antigens in urine, CSF, or blood in the presence of CSF inflammation |
|
|
Term
| What are the most likely pathogens of bacterial meningitis in patients 18-50 years old? |
|
Definition
Strep pneumoniae
N. meningitidis |
|
|
Term
| What empiric antibiotics should be given to adults aged 18-50 suspected to have bacterial meningitis? |
|
Definition
| vancomycin + cefotaxime/ceftriaxone |
|
|
Term
| What are the most likely pathogens of bacterial meningitis in adults over the age of 50? |
|
Definition
Strep pneumoniae
N. meningitidis
L. monocytogenes
gram neg bacilli |
|
|
Term
| What empiric antibiotics should be given to an adult over the age of 50 with suspected bacterial meningitis? |
|
Definition
| vancomycin + cefotaxime/ceftriaxone + ampicillin |
|
|
Term
| What are the most likely pathogens of bacterial meningitis in an immunocompromised patient? |
|
Definition
L. monocytogenes
Strep pneumoniae
gram neg bacilli |
|
|
Term
| What empiric antibiotics should be given to an immunocompromised patient suspected to have bacterial meningitis? |
|
Definition
| vancomycin + ampicillin + ceftazidine |
|
|
Term
| What are the most likely pathogens of bacterial meningitis in post-op patients? |
|
Definition
Staph aureus
Strep pneumoniae
gram neg bacilli |
|
|
Term
| What empiric antibiotics should be given to a post-op patient suspected to have bacterial meningitis? |
|
Definition
|
|
Term
| What empiric antibiotics should be given to an infant aged 0-4 weeks suspected to have bacterial meningitis? |
|
Definition
| ampicillin + cefotaxime/aminoglycoside |
|
|
Term
| What empiric antibiotics should be given to an infant aged 1-3 months suspected to have bacterial meningitis? |
|
Definition
| ampicillin + cefotaxime + vancomycin |
|
|
Term
| What empiric antibiotics should be given to a a child aged 3 months-18 years suspected to have bacterial meningitis? |
|
Definition
| vancomycin + ceftriaxone/cefotaxime |
|
|
Term
| What empiric antibiotics should be given to a patient suspected to have bacterial meningitis who had recent neurosurgery, head trauma, or CSF shunt? |
|
Definition
|
|
Term
| What empiric antibiotics should be given for a patient suspected to have bacterial meningitis who had gram positive cocci in CSF? |
|
Definition
| vancomycin + ceftriaxone/cefotaxime |
|
|
Term
| What empiric antibiotics should be given to a patient suspected to have bacterial meningitis who had gram negative cocci in CSF? |
|
Definition
|
|
Term
| What empiric antibiotics should be given to a patient suspected to have bacterial meningitis who had gram positive bacilli in CSF? |
|
Definition
| ampicillin + aminoglycoside |
|
|
Term
| What empiric antibiotics should be given to a patient suspected to have bacterial meningitis who had gram negative bacilli in the CSF? |
|
Definition
| broad-spectrum cephalosporin + aminoglycoside |
|
|
Term
| What is the first line empiric therapy for penicillin-resistant S. pneumoniae meningitis? |
|
Definition
| 3rd gen cephalosporin (ceftriaxone 2-4 g/d or cefotaxime 8-12 g/d) with or without vancomycin (2-3 g/d) |
|
|
Term
| What antibiotic has poor CSF penetration? |
|
Definition
|
|
Term
| What causes further decreased CSF penetration of vancomycin? |
|
Definition
|
|
Term
| What antibiotic can be substituded for vancomycin if dexamethasone is to be given? |
|
Definition
|
|
Term
| What is the drug of choice for penicillin-susceptible S. pneumoniae meningitis? |
|
Definition
|
|
Term
| What is the drug of choice for N. meningitidis meningitis? |
|
Definition
pen G (24 million U/day)
OR
ampicillin (12 g/d) |
|
|
Term
| What antibiotic can be used in the presence of penicillin resistance with N. meningitidis meningitis? |
|
Definition
|
|
Term
| What is first line empiric therapy for H. influenzae meningitis? |
|
Definition
| 3rd gen cephalosporins (ceftriaxone 4 g/d or cefotaxime 8-12 g/d) |
|
|
Term
| Resistance to what antibiotics is common with H. influenzae meningitis? |
|
Definition
chloramphenicol
ampicillin |
|
|
Term
| What has been proven to decrease the incidence of hearing loss and neurologic sequelae in children with H. influenzae meningitis? |
|
Definition
| dexamethasone (0.15 mg/kg q6h) |
|
|
Term
| What is the drug of choice for L. monocytogenes meningitis? |
|
Definition
ampicillin (12 g/d)
OR
pen G (24 million U/d) |
|
|
Term
| The addition of what antibiotic to first line for L. monocytogenes treatment may add synergy? |
|
Definition
|
|
Term
| What antibiotics are inactive against L. monocytogenes meningitis? |
|
Definition
| 3rd gen cephalosporins (ceftriaxone, cefotaxime) |
|
|
Term
| What should you use in a patient who has L. monocytogenes meningitis who is allergic to PCN? |
|
Definition
| TMP-SMX (10 mg/kg/d of TMP component) |
|
|
Term
| What about dexamethasone administration is important? |
|
Definition
timing
should be administered before or with the first dose of antibacterial therapy |
|
|
Term
| Why does dexamethasone need to be administered with the first dose of antibiotics in bacterial meningitis? |
|
Definition
| to counteract the initial inflammatory burst consequent to antibiotic-mediated bacterial killing |
|
|
Term
| Which is more common, acute or chronic meningitis? |
|
Definition
|
|
Term
| What are the most common pathogens of chronic meningitis? |
|
Definition
Mycobacterium tuberculosis
atypical mycobacteria
fungi (cryptococcus, coccidioides, histoplasmosis)
spirochetes (Treponema pallidum, Borrelia burgdorfori) |
|
|
Term
| What is the most common cause of fungal meningitis? |
|
Definition
|
|
Term
| What should you immediately think with a cryptococcus infection? |
|
Definition
|
|
Term
| What are predisposing factors for fungal meningitis? |
|
Definition
HIV
Hodgkin's disease
corticosteroid use |
|
|
Term
| What are the symptoms of fungal meningitis? |
|
Definition
headache with abnormal mentation
+/- meningeal signs |
|
|
Term
| How is a diagnosis of fungal meningitis made? |
|
Definition
| evaluation of capsular polysaccharide antigen in CSF |
|
|
Term
| 95% of patients with fungal meningitis have what? |
|
Definition
| HIV with positive serum antigen |
|
|
Term
| What is an encapsulated budding yeast found in soil and dried pigeon dung that can cause fungal meningitis? |
|
Definition
|
|
Term
| What signs of meningitis are rare in HIV patients? |
|
Definition
nuchal rigidity
meningeal signs |
|
|
Term
| Only about ___% of patients with fungal meningitis demonstrate nucahl rigidity and meningeal signs. |
|
Definition
|
|
Term
| What LP pathologic finding is consistent with fungal meningitis? |
|
Definition
| India ink smear on gram stain reveals budding encapsulated fungal cells |
|
|
Term
| What is a useful test in diagnosis of fungal meningitis and can be used as a screening test for patients with AIDS? |
|
Definition
| serum cryptococcal antigen |
|
|
Term
| How is the increased ICP in fungal meningitis treated? |
|
Definition
|
|
Term
| How do you treat a patient with fungal meningitis who is conscious and has a CSF cryptococcal antigen titer <1:128? |
|
Definition
| PO fluconazole 400mg/day x 10 weeks |
|
|
Term
| How do you treat a high risk patient with fungal meningitis? |
|
Definition
amphoteracin B 0.7-1mg/kg/d x 14 days
then PO fluconazole 400mg/d x 8 weeks |
|
|
Term
|
Definition
| tertiary syphilis (progressive, life-threatening) |
|
|
Term
| What organism causes neurosyphilis? |
|
Definition
|
|
Term
| What are the classic CSF findings with neurosyphilis? |
|
Definition
increased protein
lymphocytic pleocytosis
+ VDRL reagen test in CSF
(CSF findings can be normal with neg VDRL) |
|
|
Term
| What characterizes asymptomatic neurosyphilis? |
|
Definition
| abnormal CSF but normal PE |
|
|
Term
| What characterizes meningovascular neurosyphilis? |
|
Definition
chronic meningitis
cranial nerve palsies
unequal reflexes
irregular pupils |
|
|
Term
| What characterizes tabes dorsalis? |
|
Definition
decreased proprioception and vibratory sense
Argyll Robertson pupil |
|
|
Term
| What is an Argyll Robertson pupil? |
|
Definition
| accommodates but does not react to light |
|
|
Term
| What characterizes the general paresis associated with neurosyphilis? |
|
Definition
decreased concentration
memory loss
slovely, confused, irresponsible, and psychotic |
|
|
Term
| What condition is tabes dorsalis associated with? |
|
Definition
|
|
Term
| What is the best treatment for neurosyphilis? |
|
Definition
|
|
Term
| What should be done with a patient who has neurosyphilis? |
|
Definition
report it to health department!
antibiotics:
-pen G 3-4 million U IV q4h x 10-14d
-ceftriaxone 2g IM qd x 10-14d
-may add benzathine penicillin 2.4 million U IM weekly x 3 weeks after above courses |
|
|
Term
| What are the symptoms of tuberculosis meningitis? |
|
Definition
gradual onset of listlessness, irritability, anorexia, and fever
followed by headache, vomiting, seizures, and coma |
|
|
Term
| What is seen in 75% of patients with tuberculosis meningitis? |
|
Definition
| signs of active TB elsewhere in the body (ex. skin) |
|
|
Term
| What does CSF analysis show in a patient with tuberculosis meningitis? |
|
Definition
-low glucose, high protein, high ICP
-acid fast stains usually negative
-cultures negative in 15-25% of cases |
|
|
Term
| What is essential for survival from tuberculosis meningitis? |
|
Definition
| presumptive diagnosis with early empiric treatment |
|
|
Term
| What drugs can be given for tuberculosis meningitis and all have good CSF penetration? |
|
Definition
rifampin
isoniazid
prazinamide |
|
|
Term
| What can be given with tuberculosis meningitis to decrease cerebral edema? |
|
Definition
| dexamethasone 0.15 mg/kg IV or PO q6h x 1-2 weeks, then taper off over next 4 weeks |
|
|
Term
| What can cause encephalitis? |
|
Definition
herpesviruses
arboviruses
rabies virus
flavivirus |
|
|
Term
| What are the symptoms of encephalitis? |
|
Definition
disturbances of sensorium
seizures
patients are very ill |
|
|
Term
| What does CSF analysis show with encephalitis? |
|
Definition
| may be normal or show some lymphocytes |
|
|
Term
| What is another name for arboviral encephalitis? |
|
Definition
|
|
Term
| What are the symptoms of West Nile virus? |
|
Definition
fever, malaise, sore throat, headache, GI upset, lethargy, stupor progressing to coma
stiff neck and mental status changes, tremors, seizures, flaccid paralysis, muscle weakness |
|
|
Term
| What is imperative for the definitive diagnosis and treatment of West Nile virus? |
|
Definition
|
|
Term
| What do CSF labs show with West Nile virus? |
|
Definition
WBC variable
high protein
normal glucose
lymphocytic pleocytosis |
|
|
Term
| What is the treatment for West Nile virus? |
|
Definition
no specific antiviral therapy available
supportive measures:
-decrease ICP with mannitol
-monitor ICP
-ribiviran helpful |
|
|
Term
| What is a neighborhood reaction? |
|
Definition
purulent infectious process in close proximity to the CNS
infection and inflammatory process spills into the CNS |
|
|
Term
| What causes a neighborhood reaction? |
|
Definition
brain abscess
vertebral osteomyelitis
epidural abscess
subdural empyema
bacterial sinusitis
mastoiditis |
|
|
Term
|
Definition
|
|
Term
| What is amebic meningoencephalitis most often caused by? |
|
Definition
| Naegleria fowleri (brain-eating amoeba) |
|
|
Term
| What is a key history finding of patients with amebic meningoencephalitis? |
|
Definition
| recent fresh water exposure (usually children or young adults) |
|
|
Term
| How does amebic meningoencephalitis present? |
|
Definition
| signs of meningeal irritation with rapid progression to encephalitis and death |
|
|
Term
| What is the treatment for amebic meningoencephalitis? |
|
Definition
IV or intrathecal amphoteracin B
cure is RARE! |
|
|
Term
| What things can lead to a brain abscess? |
|
Definition
extension of contiguous infection
penetrating head injury
neurosurgical procedures
hematogenous spread from extracranial source |
|
|
Term
| What are the most frequently isolated microorganisms of brain abscesses? |
|
Definition
Strep viridans
Staph aureus
gram neg bacilli
anaerobes |
|
|
Term
| How does a brain abscess present? |
|
Definition
| as intracranial space-occupying lesion |
|
|
Term
| What can be a sequela of disease of the ear, nose, sinus, or body or introduced intracranially secondarily to trauma or surgery? |
|
Definition
|
|
Term
| What are the signs and symptoms of a brain abscess? |
|
Definition
headache
vomiting
drowsiness, inattention, confusion
seizure
focal neurologic deficits due to ICP |
|
|
Term
| What does CT show with a brain abscess? |
|
Definition
| contrast enhancement around a low-density core |
|
|
Term
| What radiologic test is best for early detection of a brain abscess? |
|
Definition
|
|
Term
| If you suspect a brain abscess, what test do you NOT want to do and why? |
|
Definition
LP
may lead to uncal herniation due to increased ICP (need to check CT and look for papilledema) |
|
|
Term
| What is the treatment for a brain abscess? |
|
Definition
long-term antibiotics
steroids to decrease edema
surgical I&D or aspiration |
|
|
Term
| When should a brain abscess only be treated with antibiotics? |
|
Definition
|
|
Term
| What antibiotics should be used to treat a brain abscess? |
|
Definition
| pen G + chloramphenicol + metronidazole 6-8 weeks IV, then 2-3 weeks PO |
|
|
Term
| What steroids can be used to decrease cerebral edema with a brain abscess? |
|
Definition
|
|
Term
| What are long-term sequelae of bacterial meningitis? |
|
Definition
loss of limbs
severe scarring
brain damage
hearing loss |
|
|
