Duke PA CNS Infections
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| patients with CNS infections usually exhibit some combination of __ | fever, headache, altered mental status, depressed sensorium, seizures, focal neurologic signs, and stiff neck
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| inflammation of the leptomeninges caused by infectious or noninfectious processes | meningitis
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| the most common noninfectious causes of meningitis | subarachnoid hemorrhage, cancer, and sarcoidosis
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| the three categories of infectious meningitis | acute bacterial, aseptic, subacute to chronic meningitis
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| 3/4 of patients with meningitis present before the age of __ years | 15
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| most cases of infectious meningitis occur in the __ | winter and spring
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| most cases of infectious meningitis involve children younger than __ | 5
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| __ meningitis is a disease of childhood | haemophilus influenzae
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| __ meningitis is a disease seen in all ages | pneumococcal
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| the bacteria that cause most community-acquired meningitis transiently colonize the oropharynx and nasopharynx of __ | healthy individuals
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| patients with bacterial meningitis may exhibit | fever, headache, lethargy, confusion, irritability, and stiff neck
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| stiff neck is absent in about __ of all patients with meningitis | 1/2
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| although not pathognomonic, __ is very suggestive of N. meningitidis infection | palpable purpura
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| in bacterial meningitis symptoms usually progress over __ days | 1-7
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| in acute bacterial meningitis the CSF usually contains 500-10,000 cells/mcL, mostly __ | neutrophils
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| in bacterial meningitis glucose in the CSF __ | decreases
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| in bacterial meningitis protein level __ | rises
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| a low level of CSF glucose usually indicates infection but can also occur following a __ | subarachnoid hemorrhage
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| at the time when bacterial meningitis is first suggested, __ procedures should be initiated | respiratory isolation
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| about __% of adults with bacterial meningitis die of the infection | 30
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| patients with suggested bacterial meningitis should be treated with antibiotics withing __ minutes of reaching medical care | 30
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| __ are the most frequent cause of aseptic meningitis | viral infections
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| of those cases in which a specific causal agent can be established in viral meningitis, 97% are due to __ | enteroviruses (coxsackievirus B, echovirus, mumps virus) herpes virus, adn leptospira
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| the syndrome of aseptic meningitis of viral origin begins with the acute onset of | headache (worst ever, exacerbated by sitting, standing, or coughing), fever, photophobia, and meningismus associated with CSF pleocytosis
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| in __ meningitis the CSF shows a pleocytosis of 10-2000 white blood cells/mcL | viral
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| __ meningitis is generally benign and self limited | viral
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| patients affected by HSV commonly describe a prodrome of 1-78 days of upper respiratory tract symptoms followed by the sudden onset of headache and fever | HSV
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| untreated HSV has a __% mortality rate | 70
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| WNV occurs mainly during the __ months | summer
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| __ encephalitis is always fatal, requiring major attention on prevention | rabies
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| 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 | meningitis
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| 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 | encephalitis
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| a focal infection in the brain which typically presents with focal manifestations due to "space occupying" nature of the abcess- may or may not have fever, chills or other signs of infection | brain abcess
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| this is the typical meningitis. Progressive headache, fever, neck stiffness and perhaps lethargy, over hours to 1-2 days. True medical emergency. | purulent meningitis
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| emergent treatment for purulent meningitis | STAT lumbar puncture and empiric antibiotic coverage
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| extremely low CSF glucose is usually due to __ meningitis | tuberculosis
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| CSF of purulent meningitis usually reveals __ | increased WBC's (predominantly PMN's), low CSF glucose, elevated protein, elevated opening pressure
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| usually not due to typical bacteria and is much more indolent. Few or gradual increase in symptoms. Most common organisms involved are fungi and tuberculosis. | chronic meningitis
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| CSF of chronic meningitisi usually reveals __ | WBC's mildly elevated, CSF glucose low, CSF protein elevated, opening pressure is mildly-moderately elevated
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| generally refers to any acute meningitic syndrome which is not caused by acute bacterial infection. Most often this is viral and self-limiting. | aseptic meningitis
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| the major diagnostic distinction is that usually aseptic meningitis has __ | more lymphocytes than PMN's, often the glucose is not as low, and the WBC's are not as high
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| Partially treated meningitis may be mistaken for __ | aseptic meningitis
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| encephalitis is usually due to __ and because it is a diffuse infection of the brain usually is associated with confusion, lethargy and often seizures | viruses
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| __ are often ring enhancing lesions | brain abcesses mostly and brain tumors
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| when bacteria reach the brain itself there is often a focal area of inflammation we often call __ | cerebritis
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| __ is a localized, usually bacterial, parenchymal brain infection which usually causes symptoms via compression | brain abcess
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| if meningitis is suspected, and emergent __ is necessary, even though most times the patient will get a CT scan first if available | lumbar puncture
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| if a brain abcess is suspected, __ is to be avoided because herniation could occur and the CSF studies are rarely helpful | lumbar puncture
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| don't do a lumbar puncture first on a patient with suspected meningitis and __ on physical exam | focal deficits
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| increased WBC's in the CSF indicates __ but not necessarily infection | inflammation
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| CSF gram stain with gram positive cocci in an adult with meningitis symptoms and no rash. The most likely etiologic agent is __ | Streptococcus pneumoniae
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| antibiotic to give when a patient is suspected to have pneumococcal meningitis | ceftriaxone
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| if gram negative diplococci are seen in the CSF of an adult pateint suspected to have meningitis | vancomycin
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| the meningitis associated with petechial rash in most cases | Neisseria meningitidis
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| gram negative intracellular diplococci found in the CSF of a patient with symptoms of meningitis | Neisseria meningitidis
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| usually gradual in onset, with listlessness and irritability, may have cranial nerve palsies | tuberculosis meningitis
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| brain abcesses may be associated with sinustitis, surgical procedures or hematogenous spread of other infections. Most common organisms are __ | streptococcus, staphylococcus or anaerobes
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| treatment of brain abcess | IV antibiotics for a prolonged course and usually surgical drainage
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| __ rhabdoviral infection transmitted by animal bite introducing infected saliva into the wound | rabies
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| incubation period for rabies | >10 days usually 3-7 weeks
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| prodromal symptoms include pain at the inoculation site, fever, malaize, nausea and vomiting | rabies
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| about 10 days after innoculation the CNS manifestations of rabies | delirium, painful swallowing, rage alternating with calm. Or acute ascending paralysis
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| presents in later life with rapidly progressive dementia, myoclonus, ataxia and somnolence | Creutzfeld-Jakob disease
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