Neuro - Infections Of The Cns

Front 1

• What are 3 ways the CSF differs from the rest of the body in terms of immune system protection?
  
• Why the difference?

Back 1

1. No lymphatics
   
2. 0.5% the amount of antibodies
3. Low WBCs

• The BBB prevents infectious material from entering the CSF, reducing need

Front 2

• When infection presents in the CNS, what determines the signs and symptoms?
  
• What determines the length of time for the infection to run its course?
• What determines the probability of neurologic sequelae?

Back 2

• Site of the infection
• Type of organism
• Type of organism

Front 3

• What drugs are given to reduce brain swelling/inflammation?
  
• To prevent/treat seizures?
  
• To kill the bug?
  
• For irritibility or restlessness?
  
• Fever/HA?
  

Back 3

• Corticosteroids
  
• Anticonvulsants
• Antibiotics/antiviral drugs
• Sedatives
• OTC meds

Front 4

• What is the typical reaction to somebody presenting with meningitis?
  
• What determines morbidity/mortality?
• Most susceptible, in general?
• Most susceptible, by bug?

Back 4

• Hospitalization
  
• Type of organism
• 60+ y.o.
• Adults - Streptococcus pneumoniae; Newborns - Group B Streptococci

Front 5

Clinical signs of meningitis?

Back 5

• Fever
  
• HA
  
• Stiff, painful neck, termed "Nuchal Rigidity"
  
• (+) Kernig's Sign
  
• (+) Brudzinski's Sign
  
• Photophobia

Front 6

• How to perform Kernig's Test? What is a positive result?
  
• How do you perform Brudzinski's Test? What is a positive result?
  

Back 6

• Supine, with knees and hips flexed to 90º, then passively extend the knee. (+) result is resistance to extension with hamstring pain

• Supine, then passively flex the neck and occiput (chin to chest). (+) result is pain and reactive hip flexion to relieve meningeal tension

Front 7

• Definitive diagnostic test for meningitis? What does this determine?
  
• What is the course of onset of viral meningitis?
  

Back 7

• Lumbar puncture, with analysis can determine whether the meningitis is viral or bacterial
  
• Symptoms tend to develop within 24 hour with severe HA as primary complaint, and recovery within 1-2 weeks

Front 8

What are 4 common symptoms of bacterial meningitis?

Back 8

1. Impaired CSF absorption leads to increased ICP

2. Edema

3. Seizures

4. Hydrocephalus

Front 9

• How is bacterial meningitis treated?
  
• Why might standard antibiotics be ineffective?
  
• What is done to ensure effectiveness?
• What are possible side effects when antibiotics are administered in this way?

Back 9

• Broad spectrum antibiotics with 1-3 days of isolation
  
• They may not be able to cross the BBB
• Antibiotics may be administered intrathecally
• Paraesthesia, radiculopathy, transverse myelitis due to neurotoxicity

Front 10

• What is a brain abscess?
  
• What are three ways one can occur?
• Who is most vulnerable?

Back 10

• A local brain infection, usu. opportunistic
• Penetrating wound, adjacent infection (e.g. sinusitis, otitis), spread from distance infection
• Individuals with compromised immune systems

Front 11

• How does a brain abscess progress?
  
• How is a brain abscess treated?

Back 11

• It becomes encapsulated and necrotic
  
• Surgically, either by excision or needle aspiration; If caught early antibiotics alone may be sufficient

Front 12

• What is encephalitis?
  
• What are two ways it may occur?
  
• How does it relate to meningitis?
  

Back 12

• A general inflammation of brain parenchyma (bulk substance)
  
• It's usually an opportunistic infection, either directly from a virus (1º) or as a complication or after lying dormant (2º)
  
• Different things, but may occur concurrently