Foundations II (Cholley) > Encephalitis, meningitis > Flashcards

Encephalitis, meningitis Flashcards

(37 cards)

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1
Q

How do pts w/ encephalitis present?

A
  • Fever
  • Altered mental status
  • Seizures
  • Focal neuro sx
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2
Q

What do you see on PE for encephalitis?

A
  • Papilledema
  • Rash
  • Autonomic & hypothalamic disturbances
  • Arthritis
  • Retinitis
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3
Q

What imaging do you use for dx of encephalitis?

A
  • MRI > CT
  • Start w/ CT w/out contrast if pt is SICK (faster, r/o mass lesion)
  • MRI: hyperintensity in areas of edema
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4
Q

What are contraindications to doing a lumbar puncture?

A
  • Si/sx of increased ICP
  • Severe coagulopathy
  • Skin infection
  • Mass lesion
  • If pt has any of the above, CT > LP
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5
Q

What makes up cushing’s triad?

A
  1. Respiratory depression
  2. Bradycardia
  3. HTN
    * Seen in encephalitis
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6
Q

What is cloudy CSF indicative of?

A

Bacterial meningitis

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7
Q

What are other causes of elevated WBCs in lumbar puncture sample?

A
  • Vasculitis
  • Leukemic infiltration
  • Traumatic tap*
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8
Q

What is the gold standard for dx of encephalitis?

A

Brain biopsy

- Invasive, not the initial test performed

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9
Q

How do you tx encephalitis?

A
  • Stabilize (ET tube, vent, circulatory support)
  • Antiviral therapy*
  • Tx offending agent
  • Prevent secondary bacterial infections, DVT, GI prophylaxis.
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10
Q

How can you tx increased ICP?

A
  • Elevate head to 30-45˚
  • Avoid compression to jugular veins
  • Hyperventilate
  • Corticosteroids & mannitol
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11
Q

What is empiric therapy for encephalitis? What is the % of survival?

A 
Start Acyclovir (early): decreases morbidity/ mortality
- Up to 90% survival
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12
Q

How do you prevent encephalitis?

A

Avoid vectors!

- Bug spray, barriers, avoid areas/times when mosquitos are active

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13
Q

What are classic sx of meningitis?

A
  • HA
  • Photophobia
  • N/V
  • Neck stiffness
  • Fever
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14
Q

What are complications of bacterial meningitis?

A

If not fatal, can cause:

  • neurological sequelae
  • brain damage
  • hearing loss
  • learning disabilities
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15
Q

What are characteristics of “viral” meningitis?

A
  • Aseptic
  • Often indistinguishable from bacterial meningitis based on presentation alone
  • Course usually self-limited
  • # 1 cause = entero
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16
Q

What is the typical CSF analysis for “viral” meningitis?

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A
  • Colorless

- Can be cloudy

17
Q

What is the typical CSF for encephalitis?

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A

Straw-colored

18
Q

How do neonates acquire “bacterial” meningitis?

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A

From birth canal

19
Q

Suspected bacterial meningitis = ________

20
Q

What is the #1 pathogen causing “bacterial” meningitis in neonates?

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A

Group B streptococcus

21
Q

1 cause of bacterial meningitis in babies/children?

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A

strep pneumoniae

22
Q

1 cause of bacterial meningitis in teens & young adults?

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A

Neisseria meningitidis

23
Q

1 cause of bacterial meningitis in adults?

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A

streptococcus pneumoniae

24
Q

What organism do you need to test for in pregnant women? At how many weeks should you perform?

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A

GBS

35-37 wks gestation

25
How do you tx pregnant women who are positive for GBS?
prophylactic abx during labor
26
How does "bacterial" meningitis present?
may be slow or rapid onset Classic sxs: fever, meningismus, AMS, severe HA +/- N/V, photophobia, back pain
27
How does "bacterial" meningitis present in neonates?
classic sxs + irritability, poor feeding, lethargy, high-pitched cry, "floppy", rash, +/- seizures
28
How do you dx/manage "bacterial" meningitis?
- IV access - Blood cx x 2 (diff sites, diff times) - Abx - CBC, CMP, coag - +/- CT - LP
29
Can you delay abx?
NO! if LP is delayed bc of CT scan, start abx after obtaining blood cultures
30
What meds do you use to tx "bacterial" meningitis?
Ceftriaxone or cefotaxime + Vanco + Ampicillin (if over age 50)
31
How do you tx pts w/ "bacterial" meningitis who are allergic to PCN?
Vanco + moxifloxacin | - If over 50yo, tx w/ TMP-SMX
32
Who should you give chemoprophylaxis for "bacterial" meningitis?
- Prolonged contact while in close proximity - Direct exposure to pt's oral secretions during 7 days prior to sx onset & until 24 hrs after initiation of abx therapy
33
What vaccines are available for meningitis?
Quadrivalent conjugate vaccines against A, C, W, & Y: - Menactra - Menveo Vaccines against serogroup B: - Trumemba - Bexsero
34
What "clues" indicate viral meningitis?
- HSV w/ genital lesions (usually precede meningitis sx) | - Mumps
35
Common organism responsible for bacterial meningitis in pts over 65 y/o or immunocompromised?
Listeria monocytogenes
36
Which will always have AMS: bacterial meningitis or encephalitis?
ENCEPHALITIS
37
What kind of rash is highly associated with neisseria meningitis?
petechia/purpura
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