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27 Cards in this Set
- Front
- Back
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What infectious agents are responsible for infections in the nervous system?
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Bacteria
Fungi Parasites Viruses |
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Brain abscesses show signs and symps of ther space occupying lesions but with more _____ progressions.
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Rapid
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What extracerebral locations can brain abscesses originate?
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-Blood-bourne from unknown areas, lungs, or heart
-Direct extension (parameningeal sites): otitis, cranial osteomyelitis, sinusitis -Sites of head trauma (recent or remote) or neurosurgical procedure -Infections associated with cyanotic congenital heart disease |
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Pathogens in brain abscesses are mostly _______.
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-Streptococci (aerobic & anaerobic)
*may also be gram - anaerobes or polymicrobial |
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Be careful not to misdx a pt who has a brain abscess, as ___% of abx treated pts have negative cultures.
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30%
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What are the most common presenting symps of a brain abscess?
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-HA of recent onset (most common)
-HA followed by (if untreated) increase in severity, focal signs such as hemiparesis or aphasia, followed by coma/obtundation |
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Pts with a brain abscess may have no signs of a _____ infection and half will have no _____ or ______ and ___ stiffness is rare.
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-systemic
-fever or leukocytosis -neck |
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Abscesses involving the _______ may cause seizures.
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Cortical Grey Mater
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What is the role of CSF in the dx of a brain abscess?
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CSF is non-diagnostic and should NOT be performed. Can be normal and may aggravate transtentorial herniation due to rapid expansion of the abscess
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What 2 imaging techniques are indicated to dx and monitor a brain abscess?
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-Contrast CT
-MRI |
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How do you treat a brain abscess?
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-Abx or Abx w/ aspiration or excision
-Surgery if mass effect or if abscess is against ventricular surface (may rupture into the ventricular system!) -Surgery in posterior fossa lesion (b/c potential for brain stem compression) |
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When would you use Abx alone to treat a brain abscess?
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-Surgically inaccessible
-Multiple Abscesses -Early cerebritis stage |
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What specific Abx are used to treat a brain abscess?
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-Ceftriaxone (Rocephin) plus metronidazole (Flagyl) IV
-If MRSA suspected (post-op infection or IV drug use) use Vanc *If using abx therapy alone, continue abx for 8 weeks |
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What imaging techniques are used to follow the resolution of a brain abscess?
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MRI or CT
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Where is a subdural empyema found?
What is it a direct extension from? What develops in about 1/4 of the cases? |
-Space separating the dura and arachnoid
-From direct extension of infected paranasal sinuses or less commonly from untreated chronic otitis -Cortical venous thrombosis or brain abscess |
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What are the symptoms of a subdural empyema and what other common problems do the initial symptoms resemble?
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-Lateralized HA (univeral feature), fever and obtundation then ensue, followed by progressive mass and brain swelling leading to venous thrombosis or death from herniation
-Initial symps resemble chronic otitis and sinusitis |
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What is the DDx of subdural empyema and how do you differentiate the two.
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-Meningitis (nuchal rigidity and obtundation may be present in both)
-Papilledema and Lateralizing defects more common in subdural empyema |
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What 2 imaging techniques can be diagnostic for subdural empyema?
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-Contrast CT & MRI
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What is the treatment for a subdural empyema?
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Prompt surgical drainage and high dose Abx
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What "group" of patients tend to have Malignant Otitis Externa?
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Elderly pts w/ DM (ON TEST!)
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The etioloy of Malignant Otitis Externa is due to what pathogen?
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Pseudomonas
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What is the clinical presentation of Malignant Otitis Externa?
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-Rapid progression of Otitis Externa
-Ear pain & facial swelling -Osteomyelitis of the skull base -Purulent meningitis w/ multipl CN palsies |
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Treatment of Malignant Otitis Externa is urgent. What does this treatment entail?
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-Antipseudomonal PCN or 3rd Gen Cephalosporin
-Surgical debridment *Mortality rate is high! |
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A spinal epidural abscess is located in the epidural space about the spinal cord an may cause _____ and _____, but responds well to treatment.
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Death & Paralysis
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What population has a higher incidence of spinal epidural abscesses?
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IV drug users
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How to spinal epidural abscesses present?
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Present with acute or subacute back pain.
-Usually febrile -Focal percussion tenderness -Stiff neck and HA |
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What things may the pain of a spinal epidural abscess may be mistaken for?
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-Sciatica
-A visceral abdominal process -Chest wall pain -Cervical Disc Dz *If the spinal epidural abscess goes unrecognized here, rapid weakness/paralysis can occur distal to the infection *At this point, spinal abscess should be assumed, neuroradiologic dx confirmed, and tx started. |
