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67 Cards in this Set
- Front
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meningitis |
inflammation of the membranes of the spinal cord or brain usually caused by infectious illness |
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3 types of meningitis |
bacterial viral fungal |
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age 0-1 mo bacterial meningitis patho |
group B strep e. coli listeria monocytogenes misc gram neg misc gram + |
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age 1 mo to 50 yrs bacterial men |
strep pneumo meningococci h flu listeria only if immunocomprimised |
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>50 bacterial men |
strep pneumo listeria monocytogenes gram neg bacilli |
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bacterial meningitis presentation in adults |
headache fever meningismus kernigs or bruszinskis signs of cerebral dysfunction-confusion, delirium, declining level of conscious N/V, rigors, profuse sweating, weakness, myalgia, photophobia |
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kernigs sign |
positive when the thigh is flexed at hip and knee at 90 degrees and subsequent extension in the knee is painful indicating meningeal irritation |
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brudzinskis sign |
positive when the neck is flexed towards chest eliciting involuntary flexion of hip and knee |
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meningismus |
resistance to forward neck flexion |
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bacterial meningitis in neonates |
fever absent listlessness, high pitched crry refusal to feed irritability |
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bacterial meningitis in eldery |
no fever lethargy or obtundation and with variable signs of meningeal inflammation |
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bacterial meningitis CSF |
elevated opening pressure neutrophilic pleocytosis elevated protein concentration hypoglycorrhachia-low glucose in CSF |
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bacterial meningitis dx |
lumbar puncture and gram stain and culture of CSF |
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neonate bacterial meningitis tx |
ampicillin + 3rd gen or aminoclycoside |
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age 1mo-50 yr bacterial men tx |
3rd ceph + vanco |
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AGe >50 tx |
ampicillin + 3rd gen ceph + vanco |
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decardron |
give prior to abx in bacterial men cuts down inflammatory response |
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viral meningitis peaks when |
late spring to autumn |
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viral meningitis etiology |
2/3 due to enterovirus-echovirus and coxackies may be due to arbovirus, HIV, HSV-2 |
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viral meningitis sx |
fever, headache, meningeal irritation w/ inflammatory CSF kernigs, brudzinskis-absent mild lethargy or drowsiness |
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viral meningitis CSF |
lympthocytic pleocytosis slightly elevated protein normal glucose gram stain and ink fast-no organisms |
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patients with suspected viral meningitis should have |
complete and differential blood count platelet count liver function measurement of hematocrit, ESR, BUN plasma-electrolytes, glucose, Cr, Cr kindase, aldolase, amylase and lipase |
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viral meningitis tx |
symptomatic no hospitalization analgesia antiemetics |
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fungal meningitis affects who |
immunocomprimised patients diabetes malignancy immunosuppressive therapy AIDS |
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most common pathogens of fungal meningitis |
cryptococcus neoformans-pigeons coccidoides immitis-SW US candida albicans-IV drug user, recent surgery, prolonged IV tx histoplasma capsultum-ohio and central miss. river valley blastomyces dermatitidis-midwest and SE, systemic infection, abscesses, draining sinus, ulcer aspergillus-sinusitis, granulocytopenia, immunosuppression |
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fungal men sx |
headache n/v mild encephalopathy cranial nerve deficits progress over days to weeks |
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Fungal men CSF |
pleocytosis w/ mixed of lymphocytic predominance elevated protein glucose normal or mildly depressed |
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fungal men dx |
CSF india ink stain-fungi fungal culture latex agglutination test-cryptococcal antigen |
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fungal meningitis management |
amphoteracin B monitor-CBC, BUN, Cr, electrolytes, liver function, US |
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encephalitis |
in the meninges and BRAIN PARENCHYMA |
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encephalitis most common viruses |
HSV arboviruses |
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encephalitis is most common during what seasons |
summer and fall |
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encephalitis sx acute |
headache nausea personality and behavior changes lethargy |
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encephalitis sx over 1-3 days |
seizures confusion and impaired consciousness-deep lethargy to coma hemiparesis and aphasia |
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encephalitis CSF |
lymphocytic pleocytosis mildly elevated protein normal glucose lots of RBC also order CT, MRI, EEG |
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encephalitis management |
acyclovir-HSV supportive for viral initial care in ICU tx seizures with anticonvulsant |
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brain abscess |
focal suppurative process in brain parenchyma |
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brain abscess etiology |
aerobic or anaerobic |
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brain abscess frontal lobe |
preexisting sinusitis strep intermedius |
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brain abscess post traumatic or post op |
staphylcocci |
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brain abscess temporal lobes |
complication of otitis media |
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brain abscess sx |
headache triad-headache, fever, focal deficit fever focal neuro deficit seizure N/V nuchal rigidity papilledema may be nonspecific with no fever |
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brain abscess CSF |
abnormal with nonspecific findings contraindicated in suspected parenchymal abscess |
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brain abscess dx |
CSF-abnormal ESR-elevated C reactive protein-differentiate from intracranial neoplasm blood culture occasionally positive |
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Brain abscess CT |
paranasal sinus, mastoid, middle ear, and brain scan with chest roentgenogram NOT specific to brain abscess |
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Brain absscess MRI |
best choice!!! planar imaging can distingush white/gray matter more sensitive to detecting abscess in cerebritis phase detect satellite lesions and estraparenchymal extension |
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brain abscess management |
REFER |
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spinal epidural abscess presentation |
combo of neck or back pain and focal neuro signs consistent with spinal cord compression |
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spinal epidural abscess etiology |
results from epidural or spine surgery spreads from anterior infections including vertebral body osteomyelitis or diskitis |
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spinal epidural abscess dx |
CT or MRI w/ contrast LP contraindicated, potential surgical drainage for microanalysis |
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spinal epidural abscess tx |
prolonged course of IV abx possible surgical drainage |
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TB meningitis |
results from spread of bacteria from lungs present w/ cranial nerve palsies, hydrocephalus or brain infarct chronic onset |
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TB meningitis LP |
leukocytosis with lymphocytic predominance glucose very low |
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TB meningitis tx |
multiple antituberculous drugs |
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tuberculoma |
mass lesion caused by M. tuberculosis infection most common focal brain lesion in developing world Sx-HA, focal neuro sx and signs and seizure tx-prolonged course of antituberculous drugs and neurosurgery intervention |
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potts disease |
tuberculosis of the spine neuro sx-fever and back pain verterbral body infection spreads into epidural space tx-antiTB drugs and spine stabilization |
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Lyme disease |
borrelia burgdorferi sx-lyme associated meningitis, cranial nerve palsy, syndromee of polyradiculopathy rash-erythema chronicum migrans sx-HA, neck stifness, myalgia |
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toxoplasmosis |
toxoplasma gondii TORCH infection via cat feces or undercooked meet sx-HA, mental status change, focal neuro sx |
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neurocysticercosis |
pork tapeworm tanenia solium most comma parasitic infection |
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what is the most common cause of new onset seizures in developing world |
neurocysticercosis |
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neurocysticercosis sx |
seizure, headache, increased intracranial pressure |
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neurocysticercosis tx |
albendzole, steroids, and anticonvulsants |
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CNS comps of HIV |
HIV dementia vascular myelopathy progressive multifocal leukoencephalopathy opportunistic infection primary CNS lymphoma |
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HIV associated dementia |
late complication, no tx other than aggressve HAART and supportive |
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vascular myelopathy HIV |
late complication
resembles Vit B 12 loss of vibration and joint posistion w/ sensory ataxia, spasticity and signs of hyperreflexia tx-HAART and supportive |
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progressive multifocal leukoencephalopathy HIV |
demyelinating disease of CNS caused by JC virus late complcation tx-HAART and supportive |
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HIV opportunistic infection |
toxoplasmosis and cryptococcal meningitis |
