Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Neuro Infectious
Neurology
| Question | Answer |
|---|---|
| Most common causative of meningitis in adults | S. pneumo (also N meningitidis) |
| When do LP? | suspect meningitis; not if suspect abscess |
| Glucose depressed: usually: | bac mening, or TB or fungal |
| Meningitis general S/S | HA, fever, neck / back stiffness, neuro impairment |
| Meningitis presentation | acute (hrs – days), usu w/ fever, HA, stiff neck, lethargy; usu without focal sx |
| Typical purulent meningitis orgs | N. meningitidis, S. pneumoniae, or H. influenzae |
| Chronic meningitis: orgs | TB; fungal |
| Encephalitis presentation | diffuse infxn; confusion, lethargy, often seizures; CSF may be nml |
| Increased WBC in CSF indicates: | inflammation (not necessarily infection) |
| Pneumococcal meningitis Tx | ceftriaxone (if GP diplococci seen, add Vanc, pending cx) |
| N. meningitidis | petechial rash; GN diplococci; often assoc w/DIC |
| Meningococcal meningitis: nasal carriage eliminated with: | Rifampin (alt: cipro or ceftriaxone) |
| Meningococcal meningitis: DOC | Acqueous Pen G |
| H flu meningitis | less common in adults; in setting of otitis or sinusitis; DOC ceftriaxone |
| Tuberculous meningitis | usu gradual onset; listlessness & irritability; CN palsies; active TB elsewhere; CSF inc WBC (100-150), mostly lymphs; abnml CXR; acid-fast normal |
| Abscess: common orgs | streptococcus, staphylococcus or anaerobes |
| Ring enhancing lesion is usually: | abscess or tumor |
| Abscess tx | prolonged IV Abx, surg drainage; monitor tx w/ serial scans; if <2 cm poss medical tx only |
| Rabies S/S | (> 10 days) delirium, painful swallowing, rage alternating with calm |
| Rabies incubation period | >10 days (usu 3-7 wks) (infected animal dies within 5-7 days) |
| Herpes encephalitis | more common in elderly; often medial temporal lobes; tx most pts w/ clin syndrome of viral encephalitis empirically for HSE |
| Inflammatory response of the brain with neurologic dysfunction = | encephalitis |
| Encephalitis etiology: | Usually viral (HSV |
| Encephalitis pathology: | Usually meningoencephalitis; virus invades brain parenchyma |
| ute migraine: | Ergotamine |
| Encephalitis viral agents in infants = | HSV2, CMV, rubella, Listeria mono, T pallidum, Toxo |
| Encephalitis viral agents in children = | Influenza, Japanese encephalitis, eastern equine, Murray valley |
| Encephalitis viral agents in elderly = | St Louis, Listeria mono, West Nile, eastern equine |
| Encephalitis workup | MRI (alt: CT) -> brain bx only with focal findings on MRI & rapid decomp. LP with CSF PCR. FDG-PET or CSF viral cx not typically recommended. |
| Encephalitis CSF findings: | Normal glucose, elevated protein & lymphocytes. Elevated RBCs in HSV |
| Encephalitis mgmt | Acyclovir 10mg/kg Q8h (20mg/kg for infants) to cover HSV. CMV: ganciclovir/foscarnet combo. Tx bac / fungal / vectorborne agent. Tx SIADH if develops |
| Meningitis pathology: | Organism in intravascular space -> inflammation with bac lysis & release of cell wall components into subarachnoid space -> purulent exudates -> meningeal inflammation -> inc B-B barrier permeability |
| 80% of acute bac meningitis in pts >4 wks old & immunocompetent due to: | S pneumoniae ( |
| Common ABM agents: | SP, N meningitides, L mono, staph; <10% by GNR (E coli, Klebs, enterobacter, Pseudomonas |
| ABM agents in immunocompromised patients: | L mono, S pneumo, Pseudo. Rarely TB |
| Aseptic meningitis agents | Coxsackie, echoviruses, polioviruses, enteroviruses 68-71, sometimes HSV2, mumps, HIV, TB, fungus |
| Fungal meningitis agents | Cryptococcus, candida, Fusarium; rarer Histoplasma, Coccidioides, Paracoccidioides |
| CSF with normal pressure, 500-1000 WBC, slightly elevated protein, normal glucose = | viral meningitis |
| CSF with elevated pressure, 1-10K WBC, elevated protein, decreased glucose = | bacterial meningitis |
| CSF with elevated pressure, 25-500 WBC, elevated protein, decreased glucose = | chronic or TB meningitis |
| Bacterial meningitis (ABM) mgmt: | Hosp within 90 min of clinical sxs -> tx in 60 min. Neuro ICU. IV 3G cef (Rocephin or cefotaxime). |
| ABM tx for L mono: | 3G ceph + amoxicillin |
| ABM tx for PCN-resistent Pneumococcus: | Vanco + 3G ceph |
| If ABM due to S pneumo or Influenza, give this with 1st dose of Abx: | Dexamethasone 15mg/kg Q6h x2-4 days; inhibits interleukins & stabilizes BB barrier |
| ABM tx for N meningitides (suspected due to rapidly evolving rash): | IV benzyl PCN |
| ABM duration of Abx therapy: | S pneumo 10-14 days; N meningitides 3-7 days; H flu 7 days; L mono 14-21 days; GNR 21 days |
| Fungal ABM tx: | Amphotericin B xwks or months +/- flucytosine |
| TB ABM tx: | rifampin, isoniazid, ethambutol, pyrazinamide x18-24 months |
| Most common agent of meningitis in adults | S. pneumo |
| Encephalitis presentation | diffuse infxn; confusion, lethargy, often seizures; CSF may be normal |
| N. meningitidis | petechial rash; GN diplococci; often assoc w/DIC |
| H flu meningitis: commonly found: | less common in adults; in setting of otitis or sinusitis |
| Tuberculous meningitis S/S | usu gradual onset; listlessness & irritability; CN palsies; |
| Abscess: common orgs | streptococcus, staphylococcus or anaerobes |
| Rabies S/S | (> 10 days) delirium, painful swallowing, rage alternating with calm |
| Rabies incubation period | >10 days (usu 3-7 wks) (infected animal dies within 5-7 days) |
| Herpes encephalitis: commonly found: | more common in elderly; often medial temporal lobes |
| Neonatal meningitis bugs | E coli or group B Strep (Strep agalactiae) |
| Meningitis bug in immunocompromised | Cryptococcus (positive India ink test) |
| Meningitis tx if <3 months old or immunocompromised | Add ampicillin for Listeria coverage (to usual regimen of 3G ceph +/- vanc) |
| Meningitis tx if hospital or post-op: | Ceftazidime + vanco + ampicillin |
Created by:
Abarnard
Popular Medical sets