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T4: Meningitis
Inflammatory Brain Disorders
| Question | Answer |
|---|---|
| An acute inflammation of meningeal tissue surrounding brain and spinal cord. | meningitis |
| When does meningitis usually occur? | fall, winter, or early spring |
| Meningitis is often secondary to what? | viral respiratory disease |
| Who is at risk for meningitis? | Older adults and persons who are debilitated as well as college students living in dorms, and individual living in institutions (e.g. prisoners) |
| This type of meningitis is a medical emergency and if left untreated has a near 100% mortality rate. | bacterial meningitis |
| What are the leading causes of bacterial meningitis? | Streptococcus pneumoniae, Neisseria meningitidis |
| This bacteria was once the most common cause for bacterial meningitis and why is it no longer the leading cause? | Haemophilus influenzae; due to a vaccine |
| How is meningitis contracted? | Organisms enter CNS from respiratory tract or bloodstream and may enter through wounds of skull or fractured sinuses. |
| The inflammatory response to the infection tends to increase what? | CSF production with a moderate increase in ICP |
| What occurs with the purulent secretions in bacterial meningitis? | They produce quickly and spread to other areas of the brain through the CSF and cover the cranial nerves and other intracranial structures. |
| All patients with meningitis must be observed closely for what? | Manifestations of increased ICP, which is thought to be a result of swelliing around the dura and increased CSF volume. |
| What are the key signs of meningitis? | fever, severe headache, nausea, vomiting, nuchal rigidity; coma is associated with poor prognosis; photophobia; decreased LOC; signs of increased ICP (seizures, headache) |
| If the infecting organism is meningococcus, what may be seen? | a skin rash and petechiae |
| What is an acute complication of meningitis and is also a major cause of altered mental status? | increased ICP |
| What cranial nerves can become dysfunctional with meningitis? | CN III, IV, VI, VII, VIII |
| What nerve is compressed by increased ICP? | optic nerve (CN II) |
| Ocular movements such as ptosis, unequal pupils, and diplopia are affected when these nerves are irritated.. | CN III, IV, VI |
| When CN V is irritated what results? | sensory loss and loss of corneal reflex |
| Irritation of CN VII results in what? | facial paresis |
| Irritation of CN VIII causes what? | tinnitus, vertigo, and deafness (hearing loss may be permanent) |
| What complications may occur and resolve over time? | hemiparesis (weakness/paralysis affecting one side of the body), dysphagia (difficulty swallowing), and hemianopsia (blindness over half the field of vision |
| If complications of meningitis do not resolve, the following may be suspected. | cerebral abscess, subdural empyema, subdural effusion, or persistent meningitis |
| Acute cerebral edema may cause what? | seizures, CN III palsy, bradycardia, hypertensive coma, death |
| What diagnostics are done for meningitis? | blood culture, CT scan, lumbar puncture and analysis of CSF, x-rays of skull, MRII |
| A lumbar puncture should only be completed after what has been done? | After a CT scan has ruled out an obstruction in the foramen magnum in order to prevent a fluid shift resulting in herniation. |
| Specimens of CSF, sputum, and nasopharyngeal secretions are used for what? | to identify causative organism |
| A gram-stained smear is used to detect what?/ | bacteria |
| What occurs with protein levels in the CSF with meningitis? | Usually elevated and are higher in bacteria than in viral meningitiis. |
| What occurs with the CSF glucose concentration with meningitis? | Commonly decreased in bacterial meningitis but may be normal in viral meningitis. |
| What does the CSF look like in bacterial meningitis? | purulent and turbid |
| What does the CSF look like in viral meningitis? | may be purulent and turbid or clear |
| What is the predominant white blood cell type in the CSF during bacterial meningitis? | neutrophils |
| X-rays of the skull may demonstrate what? | infected sinuses |
| CT scans and MRIs may be normal in uncomplicated meningitis but it may also reveal? | evidence of increased ICP or hydrocephalus |
| What are some commonly prescribed drugs for treating bacterial meningitis? | ampicillin,, penicillin, vancomycin, cefuroxime (Ceftin), cefotaxime (Claforan), ceftriaxone (Rocephin), ceftizoxime (Cefizox), & ceftazidime (Ceptaz); dexamethasone (Decadron) a corticosteroid may be prescribed before or with 1st dose of antibiotics |
| Why is antibiotic therapy instituted after collection of specimens and before diagnosis is confirmed? | able to cross the blood brain barrier (BBB) |
| Initial assessment of a patient with meningitis should include? | vital signs, neurologic evaluation, fluid intake and output, evaluation of lungs and skin |
| What are the overall goals of care for meningitis? | Return to maximal neurologic functioning; resolve the infection; control pain and discomfort |
| Vaccinations for this is important for prevention of respiratory infections. | pneumococcal pneumonia and influenza |
| What are the 2 meningoococcal vaccines available in the US? | meningococcal polysaccharide vaccine (MPSV4) and meningococcal conjugate vaccine (MCV4) |
| What should be given for anyone exposed to bacterial meningitis? | prophylactic antibiotics |
| What does the patient with bacterial meningitis look like? | They are usually acutely ill. The fever is high, & head pain is severe. Irritation of the cerebral cortex may result in seizures. |
| The changes in mental status and LOC depend on what? | the degree of increased ICP |
| How should the patient be positioned? | To the patient's comfort, often curled up with the head slightly extended. The HOB should be slightly elevated, when permitted after lumbar puncture. |
| What interventions can be done if the patient has photophobia? | darken the room and a cool cloth over the eyes |
| Why is it important to vigorously manage fever with meningitis? | Fever increases cerebral edema and the frequency of seizures. Neurologic damage may result from high, prolonged fever. |
| If the fever is resistant to aspirin or acetaminophen what should be done? | use of a cooling blanket or tepid sponge baths with water |
| What can happen if you reduce the temperature too rapidly? | Shivering may result, causing a rebound effect & increasing the temperature, which can raise ICP. |
| What should you do to assess for dehydration? | evaluate fluid intake and output; compensate for diaphoresis in replacement fluids |
| How do you calculate replacement fluids? | 800 mL/day for respiratory losses and 100 mL for each degree of temperature above 100.4 F |
| Which cause of meningitis is highly contagious? | meningococcal meningitis |
| What are some residual effects of meningitis? | dementia,, seizures, deafness, hemiplegia,, and hydrocephalus |
| What can be done for muscle rigidity? | progressive ROM exercises and warm baths |
| What are the most common causes of viral meningitis? | enterovirus, arbovirus, HIV, and HSV; most often spread through direct contact with respiratory secretions |
| What are the CM of viral meningitis? | headache, fever (moderate or high), photophobia, and stiff neck |
| How is viral meningitis diagnosed? | Testing of CSF. Rapid diagnosis with Xpert EV test (sample of CSF is evaluated for enterovirus); lumbar puncture (CSF may be clear or cloudy), lymphocytosis; PCR to detect viral-specific DNA/RNA |
| This is used to detect viral-specific DNA or RNA and is a highly sensitive method for diagnosing CNS viral infections. | polymerase chain reaction (PCR) |
| How is viral meningitis treated? | Treat w/antibiotics after obtaining diagnostic sample but before receiving test results (can be easily discontinued if meningitis is found to be viral); symptomatic management; full recovery expected. |
| This is an acute inflammation of the brain caused by a number of viruses, some are endemic to specific geographic areas and seasone, and can be transmitted by ticks or mosquitoes. | encephalitis |
| What kind of encephalitis can ticks and mosquitoes transmit? | epidemic encephalitis such as Eastern equine encephalitis, La Crosse encephalitis, St. Louis encephalitis, West Nile encephalitis, and Western equine encephalitis |
| Nonepidemic encephalitis may occur as a complication of what? | measles, chickenpox, or mumps |
| What is the most common cause of acute nonepidemic viral encephalitis? | HSV encephalitis |
| This type of encephalitis is common with AIDS. | CMV encephalitis |
| What are the CM of encephalitis? | fever, headache, nausea, vomiting; any CNS abnormality can occur including hemiparesis, tremors, seizures, cranial nerve palsies, personality changes, memory impairment, amnesia, & dysphasia |
| When do signs of encephalitis typically occur? | in 2-3 days; may vary from minimal alterations in mental status to coma |
| What diagnostics are done for encephalitis? | CT, MRI, PET, PCR tests for HSV DNA/RNA, blood test for West Nile viral RNA |
| What can be done to help prevent epidemic encephalitis? | mosquito control such as cleaning rain gutters, removing old tires, draining bird baths, and removing water where mosquitoes can breed as well as using insect repellant |
| What drugs are used for HSV infection? | acyclovir (Zovirax), vidarabine (Vira-A); antiseizure drugs (may be prophylaxis); |
Created by:
eblanc1
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