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Meningitis Encephali

Clinical Medicine II Spring 2012

MC bacterial cause of meningitis H.S.N. H.Flu, Strep Pneumo, Nessira meningitis
Where is listeria monocytogenes meningitis commonly seen Elderly >65
What bacteria commonly cause meningitis d/t neurosurgery S. Aureus and H. flu
When are the S. H. N. vaccines given? S: at birth regular schedule, and PPSV23 for adults >65, H: many for kids, N: Adolecents 11-18 then revaccinated 3-5yrs later
MC risk factors of bact. Meningitis exposure, travel to epidemic areas, RTI’s
Pathophysiology behind bacterial meningitis inflammation and irritation of the meninges, cerebral edema, ↑ICP, Neuro, systemic
Causes of cerebral edema BBB injury, cytotoxins, inflammation impedes reabsorbtion of CSF
What are meningeal signs signs of inflammation and irritation of the meningies : Nuchal rigidity: stiff neck (can’t touch chin to chest, Kernig’s sign: Brudzinski’s sign
If hip is flexed to 90 degrees, the pt can’t completely extend the knee Kernig’s sign
Passively flexing one’s neck,pt reflexively flexes the knee Brudzinski’s
Mild signs in increased ICP HA, confusion, irritability, N/V
Severe signs of Incresed ICP altered mental status, cushing relex, papilledema, CN palsy, herniation
↑ BP and ↓ pulse cushin reflex
What are some neurological complications of meningitis seizures, focal neuro deficits, cerebrovascular issues, sensioneural HL, cognitive impairment
MC systemic signs w/ N. meningitis Rash, Arthritis, petechial,
Systemic signs of meningitis fever, ill appearing, pericarditis, arthritis, sepsis, ARDS
Three categories of bacterial meningitis signs Meningeal signs, Increased Intercranial pressure, neurological complications
Predisposing factors to meningitis immunosuppressed, DM, HIV, exposure, travel, URI, alcoholism, UTI
Hx to ask pt for suspect of meningitis Course, signs of BM, predisposing factors, RF’s, Immunization, Drug allergies, Recent abx
Classic triad of bacterial meningitis Fever, nuchal rigidity, changes in mental status, commonly w/ HA
Course of meningitis can have either acute/fulminant where it takes over w/I hours, or slower over days,
What signs can predict the prognosis onset of hypotension, altered mental status, seizures
SXS of bacterial meningtits fever, HA, neck stiffness, ↓ consciousness, N/V, photophobia, backache, seizures
Which cause of meningitis is MC cause of a rash N. meningitis
Sign in infants of^ICP bulging fontanel
Physical signs of bacterial meningitis vital signs, Meningeal sigsn, Neuro, skin, signs of bacterial infx: fever
Labs to order with suspect of bacterial meningitis CBC, thrombocytopenia, electrolytes, BUN, creatinine, glucose, PT/PIT blood cultures, LP, UA and urine for UTI
Where do we insert needle for LP? How L3,L4 or L4L5 until you feel a pop as you go through subarachnoid space
How do we measure CSF pressure manometer connected to the stylet for the LP
Indications for a LP Infx, CNS malignancy, certain neuroillness
Risks of a LP Caustion w/ ↑ICP, thropbocytopenia, bleeding, skin infx
Complications of a LP post HA, infx, bleeding, cerebral herniation: ↑ICP, back pain, minor neuro sxs
DDx for a fever, Nuchal Rigidity, and HA F: pneumonia, influenza, URI, viral infx, GI N: MS causes, injury, arthritis, sleeping position, HA: SAH
Tx for bacterial meningitis Fluids, Abx, maybe dexamethasone to decrease neuro sxs
Aseptic Meningitis When clinical lab evidence for meningeal irritation is -, can be viral bacterial, infectious, meds, or malignancy cause
MC viral meningitis cause Enteroviruses, Herpes simplex virus type 2, HIV-ID not as common: West Nile, Varicell-zoster, Mumps
Sxs of viral meningitis viremia: signs of viral sxs, fever, HA, malaise, myalgia, anorexia, N/V, CNS invasions signs: meningeal sigsn, focal neurological deficits: less
What are some causes of aseptic meningitis spirochetes: syphilis (Treponema pallidum), Lyme (Borrelia burgdorferi) TB meningitis, Paramenigeal,
Classifications for chronic Meningitis lasting 4 wks or more, both infectious and noninfectious, subacute onset of sxs,
Noninfectious causes of chronic meningitis neoplastic, sarcoid, systemic lupus erythematosus, CNS vasculitis
Testing for chronic meningitis CBC + diff, renal fxn, LFT, ESR, ANA, TB, CXR, VDRI, UA, HIV, CSF, cultures, other on individual basis, brain biopsy last resort
What is tx for chronic meningitis empiric therapy, antiTB, or AntiFungal all depending on underlying factors
Inflammation of the brain parenchyma encephalitis, abnl brain fxn neuro signs
MC cause of encephalitis viral invasion of CNS Dx: brain biopsy
MC causes of encephalitis Arthropod-borne viruses: west nile, and herpes virus
Compare the viruses causes of encephalitis and meningitis :D
Difference b/w encephalitis and meningitis lack meningeal signs: photophobia, nuchal rigitidy, w/ many nonspecific signs of illness
Physical signs on encephalitis altered mental status, focal neuro signs, signs of underlying illness, rash, mumps: parotitis WNV: paralysis, maculopapular rash, tremors eyelids, tongue, lips, extremeties, Rabies
How can we determine bw encephalitis and meningitis neck test
Common tests for encephalitis PCR w/ HSV risks, cultures, for serology, CSF to check for inflammatory dz, CT to r/o lesions, MRI detects demylination, EEG’s often abnl, Menintis no changes,
Last resort for encephalitis dx brain biopsy
What type of encephalitis must we r/o? signs? HSV-1, temporal lobe sxs, LP w/ RBC w/o traumatic tap, HSV PCR of CSF
Tx of HSV encephalitis acyclovir
Course and prognosis of encephalitis weeks to months course, mortality 10% (even w/o tx)
Is there nuchal rigidity w/ encephalitis no. only meningitis
Created by: streetsmarts
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