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108 Cards in this Set
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- Back
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What makes the CNS unique to infection?[2]
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No direct external communication
Immunologically privileged |
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How does a CNS infection occur?[2]
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Direct invasion from a contiguous structure
Hematogenous spread |
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What is meant by the term "closed system" in terms of infection?
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The system is sterile
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Give examples of "closed systems"[4]
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Bone
Joints Vasculature CNS |
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What is the consequence of an infection of a "closed system"?
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Higher mortality rate
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In terms of mortality
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What is the fatality rate from acute CNS infections?
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25%
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What percentage of survivors are left with permanent neurological deficits?
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10%
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Meningitis
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Inflammation of the coverings of the CNS
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Inflammation of the coverings of the CNS
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Meningitis
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Encephalitis
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Inflammation of the brain parenchyma
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Inflammation of the brain parenchyma
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Encephalitis
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Myelitis
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Inflammation of the spinal cord parenchyma
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Inflammation of the spinal cord parenchyma
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Myelitis
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Meningoencephalomyelitis
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Inflammation of the meninges and the parenchyma of the brain and the spinal cord
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What microbial agents can cause meningitis?[3]
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Viral
Bacterial Fungal |
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What microbial agents can cause encephalitis?[3]
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Viral
Bacterial Fungal |
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What microbial agents can cause brain abscess?[2]
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Bacterial
Fungal |
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How does bacterial meningitis affect the brain parenchyma?[3]
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Toxic bacterial products
Stimulation of cytokine release Frank brain infarction |
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What is the toxin released by S. pneumoniae?
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Pneumolysin
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What is the action of pneumolysin?
What bacteria is it associated with? Is it an exotoxin or and endotoxin? |
Forms pores in cell membranes
S. pneumoniae Exotoxin |
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What are Virchow-Robin spaces?
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Arteries in the subarachnoid space which give off small branches into the brain parenchyma
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What is the significance of the Virchow-Robin spaces in the event of meningitis?
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Can act as a bridge by with the infection can spread to the brain parenchyma
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What type of meningitis is most serious?
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Bacterial meningitis
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Bacterial, viral or fungal
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What are the best ways to manage CNS infection?[4]
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Early recognition
Prompt intervention Rapid determination of the etiologic agent Anticipate and manage complications |
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How are meninges usually affected?
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Hematogenous seeding
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What is aseptic meningitis?
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Viral meningitis
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Does aseptic meningitis typically have complications? If so, What complications?
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No viral meningitis is self limiting
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What is septic meningitis?
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Bacterial meningitis
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Does septic meningitis typically have complications? If so what complications?
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Yes
Brain damage Coma Death |
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What percentage of adult patients with meningitis present with headache?
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21%-81%
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What percentage of adult patients with meningitis present with fever?
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59%-100%
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What percentage of adult patients with meningitis present with confusion?
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57%-96%
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What percentage of adult patients with meningitis present with nuchal regidity?
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57%-92%
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What complication is commonly seen when meningitis progresses?
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Seizure
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What are the routes of entry for a viral infection of the CNS?[3]
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Intra-axonally
Through the olfactory nerve Hematogenous spread |
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What virus commonly infects the CNS through intra-axonal route?
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Rabies virus
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What virus commonly infects the CNS through the olfactory nerve?
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HSV
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What is the most common route by which viruses invade the CNS?
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Hematogenous route
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What is the most common etiologic agent to cause bacterial meningitis (pre-1990)?
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H. influenzae type B
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What is the most common etiologic agent to cause bacterial meningitis (today)?[2]
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S. pneumoniae
Neisseria meningiditis |
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What are the meningeal signs?[3]
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Stiff neck
Brudzinski's sign Kernig's sign |
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What causes stiff neck in meningitis?
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Reflex spasm of the neck muscles due to traction on inflamed cervical nerve roots
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Describe neck stiffness that is associated with meningitis.[3]
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Greatest with flexion
Less with rotation Less with extention |
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What is Brudzinski's sign?
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Involuntary flexion of the hip and knee when the examiner flexes the neck
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Involuntary flexion of the hip and knee when the examiner flexes the neck
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Brudzinski's sign
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What is Kernig' sign?
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Limitation of straightening the leg when the hip is flexed
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Limitation of straightening the leg when the hip is flexed
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Kernig's sign
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In what other condition does meningitis signs occur?
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Subarachnoid hemorrhage
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What are the HALLMARK symptoms of meningitis?[3]
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Fever
Headache Nuchal rigidity |
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Fever, headache and nuchal rigidity are the hallmark symptoms of what condition?
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Meningitis
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Oostenbrink Clinical Decision Rule
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Determine need for lumbar puncture based on clinical presentation in children from one month to 15 years old
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Determine need for lumbar puncture based on clinical presentation in children from one month to 15 years old
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Oostenberink Clinical Decision Rule
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What is the age range in which to apply the Oostenbrink clinical decision rule
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One month to 15 years
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What score in Oostenbrink Clinical Decision Rule indicates a Lumbar puncture?
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>8.5 points
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Score of greater than 8.5 points in Oostenbrink Clinical Decision Rule
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Indicates the need for a lumbar puncture
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What is the point value for the following criteria in the Oostenbrink Clinical Decision Rule:
Duration of main symptoms |
1 pt/day (up to 10)
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What is the point value for the following criteria in the Oostenbrink Clinical Decision Rule:
Vomiting |
2 points
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What is the point value for the following criteria in the Oostenbrink Clinical Decision Rule:
Cyanosis |
6.5 points
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What is the point value for the following criteria in the Oostenbrink Clinical Decision Rule:
Altered level of consciousness |
8.0 points
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What is the point value for the following criteria in the Oostenbrink Clinical Decision Rule:
Meningeal irritation |
7.5 points
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What is the point value for the following criteria in the Oostenbrink Clinical Decision Rule:
Petechiae |
4.0 points
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What is the point value for the following criteria in the Oostenbrink Clinical Decision Rule:
C-reactive protein[5] |
CRP<5 0 points
CRP<10 0.5 points CRP<15 1.0 points CRP<20 1.5 points CRP>20 2.0 points |
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What is the Nigrovic CSF Rule?
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Predicts bacterial meningitis based on the findings of CSF sample
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Predicts bacterial meningitis based on the findings of CSF sample
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Nigrovic CSF rule for predicting bacterial meningitis
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What is the criteria for a positive Nigrovic test?
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1 point (the presence of any of the criteria stated)
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What is the condition for postive Nigrovic test for the following condtion:
CSF gram stain |
Gram stain positive for the presence of organisms
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What is the condition for postive Nigrovic test for the following condtion:
CSF protein |
>79mg/dL
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What is the condition for postive Nigrovic test for the following condtion:
Seizure |
Seizure related to the current episode
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What is the condition for postive Nigrovic test for the following condtion:
Peripheral absolute neutrophil count |
>10000cells/mm3
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What is the condition for postive Nigrovic test for the following condtion:
CSF absolute neutrophil count |
>1000cells/mm3
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What are the viral causes for encephalitis?[7]
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Herpes virus
Enterovirus Arboroviruses Rabies virus HIV HTLV-1 Paramyxoviruses |
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What are the bacterial causes for encephalitis?[3]
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Legionella pnumoniae
Borrelia burgdorferi Treponema Pallidum |
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What is the fungal cause for encephalitis?
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Cryptococcus neoformans
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What are the parasitic causes for encephalitis?[2]
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Plasmodium falciparum
Trypanosomes |
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What are the symptoms of encephalitis?[3]
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Headache
Fever Disturbed level of consciousness |
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What condition presents with headache, fever and disturbed level of consciousness?
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Encephalitis
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Which is more severe clinically:
Encephalitis or Viral meningitis |
Encephalitis
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How does abscess damage the CNS?
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Pressure from the exudates
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Early Cerebritis/Late Cerebritis/Early Capsule/Late Capsule:
Early infection inflammation, poorly demarcated, perivascular infiltrates |
Early Cerebritis
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Early Cerebritis/Late Cerebritis/Early Capsule/Late Capsule:
Reticular matrix developing necrotic center |
Late Cerebritis
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Early Cerebritis/Late Cerebritis/Early Capsule/Late Capsule:
Neovascularity, nectrotic center surrounded by a reticular network |
Early Capsule
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Early Cerebritis/Late Cerebritis/Early Capsule/Late Capsule:
Collagen capsule, necrotic center, gliosis around the capsule |
Late Capsule
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Most common organism to cause encephalitis?
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Streptococcus
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What type of organisms commonly infect infants?
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Gram negative organisms
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What is the pressure with Bacterial infection of CNS?
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Normal to high
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What is the pressure with Viral infection of CNS?
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Normal
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What is the pressure with Fungal infection of CNS?
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Normal to high
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What is the pressure with TB infection of CNS?
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High
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What is the WBC count with Bacterial infection of CNS?
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10000-100000cells/mm3
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What is the WBC count with Viral infection of CNS?
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<100cells/mm3
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What is the WBC count with Fungal infection of CNS?
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20-500cells/mm3
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What is the WBC count with TB infection of CNS?
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50-500cells/mm3
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What is the pecentage of PMNs in the WBC count with Bacterial infection of CNS?
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>80%
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What is the pecentage of PMNs in the WBC count with Viral infection of CNS?
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<20%
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What is the pecentage of PMNs in the WBC count with Fungal infection of CNS?
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<50%
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What is the pecentage of PMNs in the WBC count with TB infection of CNS?
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~20%
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What is the RBC count with Bacterial infection of CNS in the CSF?
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Slight increase
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What is the RBC count with Viral infection of CNS in the CSF?
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Normal
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What is the RBC count with Fungal infection of CNS in the CSF?
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Normal
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What is the RBC count with TB infection of CNS in the CSF?
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Normal
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What is the protein with Bacterial infection of CNS in the CSF?
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Very high
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What is the protein with Viral infection of CNS in the CSF?
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Normal
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What is the protein with Fungal infection of CNS in the CSF?
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High
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What is the protein with TB infection of CNS in the CSF?
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High
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What is the glucose with Bacterial infection of CNS in the CSF?
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<40
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What is the glucose with Viral infection of CNS in the CSF?
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Normal
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What is the glucose with Fungal infection of CNS in the CSF?
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<40
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What is the glucose with TB infection of CNS in the CSF?
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<40
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