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57 Cards in this Set
- Front
- Back
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how are brain abscesses spread? which is most common?
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contiguous*
hematogenous post-traumatic cryptogenic (unknown cause) |
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mechanism behind continguous spread?
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sinus infx spreads to braIN
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which organism presents with hematogenous seeding
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staph (component of endocarditis)
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most common location for brain abscess
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temporal/frontal (#1)
frontal/parietal cerebellar occipital |
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what do multiple location imply about brain abscess
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hematogenous seeding
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what is the most common bacterial etiology of brain abscess
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strep (non-pneumococcal)
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when is fungal brain abscess seen?
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in poorly controlled DM
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clinical manifestations of brain abscess?
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absent fever
indolent presentation HA focal neuro findings/seizures N/V (from incresaed P) nuchal rigidity uncommon |
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when is nuchal rigidity normally seen?
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hallmark of meningitis
it only occurs in abscess if it ruptures into ventricular system --> inflammatory changes |
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Dx tests for brain abscess?
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MRI
CT **LP SHOULD NOT BE PERFORMED** |
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why should LP not be performed in suspected brain abscess, but should be done in meninngitis
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in meningitis: increased P in CSF so LP will release that P, which is good!
in abscess, increased P in cranium, putting P on bony encasement around brain, and swelling in parenchyma --> increasd P in ventricles. if LP done, P is released and brain comes through and herniates- this is DEADLY! |
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when should you do LP?
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don't do it if CT confirms abscess
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tx of brain abscess?
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medical and/or surgical
empiric ABx tx strep and staph, but don't treat others |
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when should surgery be done in brain abscess?
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it there is about to be a rupture --> lots of cerebral edema
then you shouldu open up skull and remove abscess |
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what will you see on CT of long-term inflammation
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ring around abscess, representing chronic inflammation
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what is mucor?
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a fungus that commonly infects pts with DM (it needs high blood sugar to survive)
leads to DEATH! |
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what are the other suppurative foci?
which is an emergency situation? |
cranial subdural empyema*
spinal subdural empyema* epidural abscess |
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sequellae of spinal subdural empyema
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permanent paralysis and radicular pain
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epidural abscess
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in thoracic area
present with cord compression --> bowel/bladder probs (urinary retention) or leg weakness |
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what is cranial epidural abscess related to?
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frontal sinus disease and osteomyelitis
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features of cranial subdural abscess
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emergency!
bacteremia HA Seizures same bacteriology as in brain abscess |
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fesatures of paraspinal abscess
how does it spread? tx? |
can be epi or subdural
usually from bacteremia or contiguous spread surgical drainage required to prevent spinal cord compression |
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which is the most common organism that --> paraspinal abscess
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staph aureus
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clinical presentation of spinal subdural abscess
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radicular pain
urinary retention leg weakness hyperreflexia |
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tx of spinal subdural abscess
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steroids
ABx surgical decompression |
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CSF analysis of spinal epidural abscess
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small # of polys wiht elevated protein and normal or low glucose
culture usually negative |
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infectious etiologies of chronic meningitis
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TB
cryptococcus coccidiomycosis histoplasmosis lyme dz syphilis |
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when to suspect TB meningigits?
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in pts who grew up in TB endemic areas or ppl w TB who weren't fully treated
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presentation of TB meningitis
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fever
HA change in mental status |
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population that usually gets cryptococcus
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usually immunocompromised
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dx of cryptococcus
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india ink and crypto ag useful
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why is tb meningitis so difficult to dx
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PPD often -
AFB usually - |
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when does lyme meningitis occur
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can occur in any stage in lyme
accompanies Bell's palsy |
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frequency of syphilitic meningitis
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40% in secondary
tertiary, more frequently |
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manifestation of meningovascular syphilis
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stroke like syndrome
seizures if adult has new onset seizures, r/o syphilis |
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pathophys of parenchymatous neurosyph
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destruction of nerve cells in cerebral cortex, manifesting as general "paresis" and tabes dorsalis
uveitis deafness optic neuritis or atrophy |
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what does "paresis" stand for? when is it seen
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personality
affect reflexes eye sensorium intellect speech parenchymatous neurosyphilis |
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what is tabes dorsalis
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shooting pains
ataxia sphincter siturbance peripheral/cranial neuropathy |
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presentation of neurocysticercosis
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seizures
CSF has lymphocytic pleocytosis low glucose |
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dx of neurocytosis
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serologies
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presentation of encephalitis
presentation of meningitis |
confusion initially
no stiff neck or photophobia no altered sensorium initially, just HA/fever CSF exam is similar in both |
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noninfectious etiologies of brain abscess
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neoplasm
sarcoid vasculitis drug induced (from NSAIDS) |
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prevention of neurosarcoid
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steroids
also start pt on TB drugs b/c dx of TB not excluded for several weeks |
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whihc viruses will have RBCs in CSF
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HSV
CTFV CEB |
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where does HSV encephalitis present
tx |
frontal/parietal localization
acyclovir |
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who get st. louis encephalitis
sequelae |
adults >50 yo
20% mortality 20% neurologic sequelae |
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vector for st. louis encephalitis
reservoir |
mosquitos
birds |
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who gets EEE?
sequelae |
children, mostly
75% mortality high amt of neuro sequelae |
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vector of EEE?
reservoir? |
daytime feeding mosquito
birds |
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who gets WEE?
sequelae? |
infants and adults >50
5-15% mortality few neuro sequellae |
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who gets CA enceph?
sequelae vector reservoir? |
children
<1% mortality mosquito rodent |
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vector of WNV (specific)
incubation pd fatality? |
C. pipiens
5-15 days self limited, but 3-15% fatality in elderly |
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presentation of WNV
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fever >100
altered MS flaccid paralysis possible |
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Post infectious encephalitis
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demyelination in white matter, no direct infection
follows viral illness by 5-21 days (MMR, mycoplasma, varicell, EBV, other viral URIs) |
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GB syndrome - when do they occur
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66% are post-infectious
5% post surgical assoc with lymphoma and SLE >500 cases after swine flu vaccine in 1976 |
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CSF exam of GB?
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elevated protein w/o pleocytosis
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tx of GB
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plamapheresis or IV gammaglobulin
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