CM Neurology
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| Clinical Presentation of Meningitis | 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.
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| Encephalitis definition | 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
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| Brain Abscess definition | a focal infection in the brain which typically presents with focal manifestations due to “space-occupying” nature of the abscess – may or may not have fever, chills or other signs of infection.
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| Which type of meningitis is considered to be the 'typical meningitis'? | Purulent meningitis. Onset over 1-2 days. Neck is stiff on exam. Pt needs emergent lumbar puncture and empiric abx coverage
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| Name the typical organisms that cause purulent meningitis | N. meningitidis, S. pneumonia, H. influenzae
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| CSF results in purulent meningitis | markedly elevated WBC's (predominantly PMN's), low CSF glu, elevated protein and protein and opening pressure
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| Most common organisms cauing chronic meningitis | fungi and tuberculosis
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| CSF results in chronic meningitis | WBC's mildly elevated (mostly lymphocytes), CSF glu low (if really low, then TB), low protein, opening pressure is mildly-moderately elevated
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| Where do you perform a lumbar puncture? | L3 interspace
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| If nothing grows out of the culture, the pt likely has | asceptic meningitis. May be indistiguishable from purulent meningitis initially. Asceptic has more lymphocytes than PMN's
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| What is a serology | An immune test for antibodies for a specific organism. Quicker than culture which waits on growth of an organism.
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| A recent treatment for _______ is a red flag for partially treated meningitis | otitis media; or anything for which patient may have received abx that masks the full symptoms and CSF findings of purulent meningitis
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| An infected, swollen brain | encephalitis. Almost always lethargic and confused.
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| Common cause of encephalitis | Viruses (herpes or arboviruses). CSF may be normal or only mildly abnormal
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| Which is the only encephalitis for which there are antivirals? | Herpes Simplex. Most will be treated empirically for Herpes Simplesx, Otherwise, supportive care.
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| What is the normal route of bacteria getting to the brain? | Via the bloodstream.
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| Cerebritis | bacteria in the brain cause a focal inflammation. bacteria multiply and our immune system reacts, this area coalesces into a “pocket” of pus with a surrounding capsule.lesions cause surrounding edema with significant mass-effect. Often ring-enhancing
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| When should you avoid lumbar puncture? | If brain abscess is suspected because herniation could occur and the CSF studies are rarely helpful. Treat with abx
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| Brain abscesses present with what type of symptoms? | compression symptoms (space-occupying lesion)
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| What number of WBC's in the CSF indicates likelihood of infection? | Over 100 WBCs
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| Predominance of PMNs in the CSF suggests | bacterial meningitis
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| Predominance of lymphocytes in the CSF suggests | usually not bacterial, viral or some other form of inflammation
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| Depressed glucose in the CSF suggests | bacterial or TB (possibly fungal)
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| Most common cuase of meningitis in adults | Streptococcus pneumoniae
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| Gram positive cocci meningitis is treated with | vancomycin
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| This type of meningitis is found among close contacts (ex: military recruits) | Neisseria meningitidis (Meningococcal Meningitis)
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| Which meningitis is associated with petechial rash? | Meningococcal meningitis (N. Meningitidis)
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| What is the tx of choice for Meningococcal meningitis? | Acqueous Pen G
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| ______ meningitis becomes a consideration in pts who develop meningitis in the setting of otitis or sinusitis | H. Flu Meningitis
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| Tuberculous Meningitis has what type of onset | slow. Has a prediliction for the base of the brain (where your cranial nerves are and your pituitary). CN palsies, TB elsewhere - CXR should be abnormal
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| Focal deficits with increased ICP rather than high fever, or meningismus | Brain abscess
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| Ring-enhancing lesion on CT is seen in | Brain abscesses
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| Treatment for Brain abscess | IV abx for a prolonged course and usually surgical drainage
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| What is the incubation period for rabies | >10 days - usually 3-7 weeks. Symptoms follow
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| Ascending Paralysis (over days to a week) is associated with | Rabies
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| What is the primary method of prevention for arboviral encephalitis? | Prevention of mosquito bites
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| Rapidly progressive (over months) dementia plus tremors, think of | Creutzfeld-Jakob Disease.
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