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17 Cards in this Set
- Front
- Back
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What is meningitis? |
Inflammation of meninges, may be due to infection or blood (folowing SAH). Usually rfrs to infection of meninges. |
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Bacterial causes of meningitis? |
strep pneumonia, strep B, neisseria meningitides, staph aureus, Listeria, E Coli, TB, T. Pallidum (syphilis) |
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viral causes of meningitis |
Mumps Herpes HIV Epstein Barr Enterovirus |
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Meningitis presentation/ history? |
Generally begins with headache, fever, leg pain, cold peripheries, progresses to photophobia, neck stiffness and altered consciousness (can often indicate complication like cerebral oedema or venous sinus thrombosis) |
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Classic triad of Meningitis? |
Headache, neckstiffness and fever |
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Kernigs sign? |
positive in meningitis when flex hip to 90 degrees, nee cannot be extended due to tension in the hamstrings |
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Brudzinski's sign? |
positive in meningitis When neck is flexed, hips and knees are involuntarily flexed as well |
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Prognosis of bacterial meningitis? |
25% overall mortality when treated 100% mortality if left untreated |
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Prognosis of viral meningitis? |
benign self limiting within 4-10days with no serious sequale |
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Meningococcal septicaemia? |
there is a non blanching puperic and petechial rash along with SIRs/ signs of shock |
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What might be seen O/E of meningitis patient? |
kernigs and brudzinskis signs pale and cold peripheries fundoscopy - papilloedema due to increased CSF pressure impaired consciousness vasculitic rash |
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Investigations to do when there is a Meningitis like picture? |
sepsis screen: Lactate, WCC, Blood cultures blood glucose (low in bacterial M) throat swab (viruses?) Lumbar Puncture (CSF Microscopy urgent) CT Scan before LP if signs of SOL ( To avoid coning on LP) |
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Signs indicating a SOL? |
Altered consciousness focal neurological loss papillodema immunocompromise new seizures previous mass lesion head pain worsening on bending forward CT before LP if any of above are present |
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How does the CSF typically change if there is bacterial meningitis? |
appearance: turbid and purulent mononuclear cells: raised and <50 (norm <5) polymorphs: raised high 200-300 protein: raised 0.5-2 (since protein is present in the bacteria and theyre making more protein) Glucose: reduced <50 (bacteria use it for energy) |
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How does the CSF typically change if there is viral meningitis? |
appearance: clear - turbid mononuclear cells: raised 10-100 polymorphs: normal/ nill protein: slightly raised 0.4-0.8 (since protein is present in the viruses just not as much as in bacteria and theyre making protein) Glucose: reduced >50 (normal) |
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Management of Meningitis? |
Give antimicrobials right away if suspected Cefotaxime 2g 6 hourly IV Add Ampicilin 2g 4 hourly or co-trimaxazole if listria risk ( in immunocompromised patients.) IV fluids and inotropes if Sepsis TB Men. is treated for 9 months |
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Headache Red Flags |
thunder clap - SAH |
