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DU PA CNS Infections

Duke PA CNS Infections

patients with CNS infections usually exhibit some combination of __ fever, headache, altered mental status, depressed sensorium, seizures, focal neurologic signs, and stiff neck
inflammation of the leptomeninges caused by infectious or noninfectious processes meningitis
the most common noninfectious causes of meningitis subarachnoid hemorrhage, cancer, and sarcoidosis
the three categories of infectious meningitis acute bacterial, aseptic, subacute to chronic meningitis
3/4 of patients with meningitis present before the age of __ years 15
most cases of infectious meningitis occur in the __ winter and spring
most cases of infectious meningitis involve children younger than __ 5
__ meningitis is a disease of childhood haemophilus influenzae
__ meningitis is a disease seen in all ages pneumococcal
the bacteria that cause most community-acquired meningitis transiently colonize the oropharynx and nasopharynx of __ healthy individuals
patients with bacterial meningitis may exhibit fever, headache, lethargy, confusion, irritability, and stiff neck
stiff neck is absent in about __ of all patients with meningitis 1/2
although not pathognomonic, __ is very suggestive of N. meningitidis infection palpable purpura
in bacterial meningitis symptoms usually progress over __ days 1-7
in acute bacterial meningitis the CSF usually contains 500-10,000 cells/mcL, mostly __ neutrophils
in bacterial meningitis glucose in the CSF __ decreases
in bacterial meningitis protein level __ rises
a low level of CSF glucose usually indicates infection but can also occur following a __ subarachnoid hemorrhage
at the time when bacterial meningitis is first suggested, __ procedures should be initiated respiratory isolation
about __% of adults with bacterial meningitis die of the infection 30
patients with suggested bacterial meningitis should be treated with antibiotics withing __ minutes of reaching medical care 30
__ are the most frequent cause of aseptic meningitis viral infections
of those cases in which a specific causal agent can be established in viral meningitis, 97% are due to __ enteroviruses (coxsackievirus B, echovirus, mumps virus) herpes virus, adn leptospira
the syndrome of aseptic meningitis of viral origin begins with the acute onset of headache (worst ever, exacerbated by sitting, standing, or coughing), fever, photophobia, and meningismus associated with CSF pleocytosis
in __ meningitis the CSF shows a pleocytosis of 10-2000 white blood cells/mcL viral
__ meningitis is generally benign and self limited viral
patients affected by HSV commonly describe a prodrome of 1-78 days of upper respiratory tract symptoms followed by the sudden onset of headache and fever HSV
untreated HSV has a __% mortality rate 70
WNV occurs mainly during the __ months summer
__ encephalitis is always fatal, requiring major attention on prevention rabies
inflammation of the tissues surrounding the brain-typically an acute illness evolving over hours to at most days, usually with fever, headache, neck stiffness, and lethargy. Usually without focal signs meningitis
generalized or diffuse inflammation or infection of the brain tissue itself- usually with fever, headache, lethargy or confusion and sometimes coma-usually without focal neurologic manifestations encephalitis
a focal infection in the brain which typically presents with focal manifestations due to "space occupying" nature of the abcess- may or may not have fever, chills or other signs of infection brain abcess
this is the typical meningitis. Progressive headache, fever, neck stiffness and perhaps lethargy, over hours to 1-2 days. True medical emergency. purulent meningitis
emergent treatment for purulent meningitis STAT lumbar puncture and empiric antibiotic coverage
extremely low CSF glucose is usually due to __ meningitis tuberculosis
CSF of purulent meningitis usually reveals __ increased WBC's (predominantly PMN's), low CSF glucose, elevated protein, elevated opening pressure
usually not due to typical bacteria and is much more indolent. Few or gradual increase in symptoms. Most common organisms involved are fungi and tuberculosis. chronic meningitis
CSF of chronic meningitisi usually reveals __ WBC's mildly elevated, CSF glucose low, CSF protein elevated, opening pressure is mildly-moderately elevated
generally refers to any acute meningitic syndrome which is not caused by acute bacterial infection. Most often this is viral and self-limiting. aseptic meningitis
the major diagnostic distinction is that usually aseptic meningitis has __ more lymphocytes than PMN's, often the glucose is not as low, and the WBC's are not as high
Partially treated meningitis may be mistaken for __ aseptic meningitis
encephalitis is usually due to __ and because it is a diffuse infection of the brain usually is associated with confusion, lethargy and often seizures viruses
__ are often ring enhancing lesions brain abcesses mostly and brain tumors
when bacteria reach the brain itself there is often a focal area of inflammation we often call __ cerebritis
__ is a localized, usually bacterial, parenchymal brain infection which usually causes symptoms via compression brain abcess
if meningitis is suspected, and emergent __ is necessary, even though most times the patient will get a CT scan first if available lumbar puncture
if a brain abcess is suspected, __ is to be avoided because herniation could occur and the CSF studies are rarely helpful lumbar puncture
don't do a lumbar puncture first on a patient with suspected meningitis and __ on physical exam focal deficits
increased WBC's in the CSF indicates __ but not necessarily infection inflammation
CSF gram stain with gram positive cocci in an adult with meningitis symptoms and no rash. The most likely etiologic agent is __ Streptococcus pneumoniae
antibiotic to give when a patient is suspected to have pneumococcal meningitis ceftriaxone
if gram negative diplococci are seen in the CSF of an adult pateint suspected to have meningitis vancomycin
the meningitis associated with petechial rash in most cases Neisseria meningitidis
gram negative intracellular diplococci found in the CSF of a patient with symptoms of meningitis Neisseria meningitidis
usually gradual in onset, with listlessness and irritability, may have cranial nerve palsies tuberculosis meningitis
brain abcesses may be associated with sinustitis, surgical procedures or hematogenous spread of other infections. Most common organisms are __ streptococcus, staphylococcus or anaerobes
treatment of brain abcess IV antibiotics for a prolonged course and usually surgical drainage
__ rhabdoviral infection transmitted by animal bite introducing infected saliva into the wound rabies
incubation period for rabies >10 days usually 3-7 weeks
prodromal symptoms include pain at the inoculation site, fever, malaize, nausea and vomiting rabies
about 10 days after innoculation the CNS manifestations of rabies delirium, painful swallowing, rage alternating with calm. Or acute ascending paralysis
presents in later life with rapidly progressive dementia, myoclonus, ataxia and somnolence Creutzfeld-Jakob disease
Created by: bwyche