Exam 15: Infectious & Inflammatory D/O of the Nervous Sysytem
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| Infection or inflammation of the nervous system commonly interferes with | function
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| Meningitis | an acute infection of the meninges (membranes that cover the brain and the spinal cord).
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| Meningitis: Causative agents | viral (aseptic), bacterial (septic) most common, or fungal (p. 1041).
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| Meningitis: Most common causative microorganisms include | Meningococcus.
Streptococcus.
Staphylococcus.
Pneumococcus.
Hemophilus Influenzae.
Viral agents: Herpes simplex mumps or enteroviruses.
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| Opisthotonos | An extreme hyperextension of the neck and arching of the back
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| Kernig's sign | Inability to extend the leg when the thigh is flexed on the abdomen without extreme pain.
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| Brudzinski's sign | Flexion of the neck produces flexion of the hips and knees.
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| Photophobia | Sensitivity to light
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| Petechiae associated with | meningococcal meningitis.
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| LP is contraindicated in the presence | increased ICP due to potential herniation of the brain stem).
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| Meningitis: Medical Management (Meds) | Ampicillin, penicillin, piperacillin
Third generation cephalosporin ex: Rocephin, Claforan.
Penetrates the blood-brain barrier.
Given intravenously (IV) or intrathecal.
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| Meningitis: Steroids are given to | Decrease increased ICP
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| Meningitis: Anticonvulsant therapy | if seizures occur
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| Meningitis: Prophylactic antibiotic therapy | for persons having recent contact with a patient with bacterial meningitis
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| Meningitis: carefully observe for complications | (a) Seizures
(b) DIC P. 1041
(c) Shock
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| meningitis is a communicable disease. | Respiratory Isolation
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| Encephalitis ("sleeping sickness") | Inflammation of the brain and or spinal cord (central nervous system) characterized by pathological changes in the gray and white matter with nerve cell destruction. The course of the disease and nursing care closely resemble that of meningitis.
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| Encephalitis ("sleeping sickness") can be caused by | bacteria,spirochetes, protozoa, fungi or viruses (most often a virus).
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| Meninges | Dura mater.
Arachnoid/subarachnoid mater.
Pia mater.
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| Encephalitis: Dx Evaluation | Patient history and physical examination.
Lumbar puncture (elevated CSF pressure, but fluid is clear). May culture CSF for virus.
MRI, PET.
Serologic testing (for the virus).
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| Encephalitis: Medical Management | (a) Depends on symptoms.
1) Control of ICP as necessary (Mannitol).
2) Corticosteroids.
(b) IV therapy ↑ if unconscious.
(c) Anti-virals if cause is Herpes Simplex.
1) ↓ mortality from 70 to 30%.
2) Acylovir-preferred.
3) Vidarabine.
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| Encephalitis: Potential Seqaulae (complications) | (a) Memory impairment
(b) Anosmia
(c) Personality and behavioral changes
(d) Hemiparesis
(e) Epilepsy
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| Guillian-Barre syndrome | (also called acute inflammatory polyradiculopathy or post-infectious polyneuritis) that results in widespread inflammation and demyelination of the peripheral nervous system.
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| Guillian-Barre syndrome: Causes | Cause is unknown but believed to be an autoimmune reaction.
(a) Called a syndrome because it is not clear what is the specific agent involved.
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| Guillian-Barre syndrome: Etiology | Occurs equally in men and women. Pts give Hx of a recent infection particularly of the respiratory tract (viral). Also Pts who had recent trauma, Sx or viral immunization or HIV infection. Antibodies attack Schwann cells. Demyelination occurs.
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| Guillian-Barre syndrome: S&S | Starts in lower extremities and moves upward. Cranial nerve involvement results in difficulty chewing, talking, and swallowing and breathing.
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| Guillian-Barre syndrome: Dx Tests | May be difficult.
Lumbar puncture -cerebral spinal fluid has elevated protein levels.
Nerve conduction velocity test to identify slow impulse transmission.
CT scan may be done to rule out tumor or stroke.
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| Guillian-Barre syndrome: Medical Management | Supportive Therapy.
Corticosteroids.
Plasmapheresis.
IV Immunoglobulins.
Definitive airway management & mechanical ventilation.
IV Fluids.
TPN, NG tube feedings.
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| Brain abscess: | A collection of purulent material (pus) in the brain resulting from a local or systemic infection.
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| Brain abscess: Etiology | Primary cause is direction extension from ear, tooth, mastoid or sinus infection. Staph and strep are primary organisms.
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| Brain abscess: S&S | Focal symptoms reflect the location of the abscess and the structures it affects.
Fever, Headache,Increased ICP.
Mental deterioration, drowsiness, confusion.
Seizures (30% of cases)
Visual disturbances.
Hallucinations.
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| Brain abscess: medical Management | (a) Antimicrobial therapy is the primary treatment.
(b) Craniotomy - if abscess is encapsulated.
(c) Other manifestations are treated symptomatically.
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| AIDS dementia | subacute encephalitis
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| AIDS Etiology | More than 80% of patients with advanced HIV disease will have neurologic signs and symptoms either from HIV itself or as a result of opportunistic infections that affect the brain.
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| AIDS: Global cognitive dysfunction | i. Progression of memory loss and difficulty concentrating to generalized impairment of intellect, awareness, and judgment
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| AIDS: Opportunistic Infections | i. Meningitis
ii. HSV
iii. Cytomegalovirus
iv. Toxoplasmosis
v. Cryptococcal meningitis
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| AIDS: Diagnosis | (1) Serologic studies
(2) Analysis of CSF through lumbar puncture
(3) CT scan and MRI
(4) Cerebral biopsy in some cases to make differential diagnosis.
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| AIDS: Medical Management depends on infection | (1) Anti-viral, anti-fungal and anti-bacterial agents
(2) Radiation to affected part of the brain
(3) IV or po fluids to correct dehydration or shock
(4) Anticonvulsants for seizure control
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