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Meningitis Encephali
Clinical Medicine II Spring 2012
| Question | Answer |
|---|---|
| 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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