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Infectious Neurological Conditions

Terms in this set (36)

What is meningitis?
Inflammation of the meninges surrounding the brain and spinal cord
What is the most common cause of meningitis?
viral (not as serious)
What is the most serious etiology of meningitis?
bacterial (not as common as viral)
What causes chronic meningitis and how long does it typically occur before it is diagnosed?
~2 weeks
- fungal etiology (slow growing)
- Mycobacterium tuberculosis
How is meningitis contracted?
- Crossing the BBB
- Surgery
- Anatomical defect (acquired: skull fracture, congenital: spina bifida)
- Ear or sinus infection
What is the most common cause of bacterial meningitis in adults?
Streptococcus pnumoniae
What form of bacterial meningitis is highly contagious?
Neisseria meningitidis
Which type of meningitis requires respiratory isolation in a private room with droplet precautions?
N. meningitidis
What type of meningitis was previously the leading cause of meningitis in children, but now due to vaccines, is not as common?
H. influenzae
To which type of meningitis are pregnant women, newborns, geriatric and the immunocompromised most susceptible to?
Listeria monocytogenes
Which bacterial meningitis is found most commonly in newborns?
Group B strep
Based on age, which strains of bacteria could be responsible for meningitis in a 14 year old?
N. meningitidis
S. pneumoniae
What is the classic triad for bacterial meningitis in children and adults?
- Headache
- Fever
- Stiff neck (nuchal rigidity)
What is a common sign of bacterial meningitis seen only in infants?
bulging fontanelle
What is the physical exam finding that results in the pt bending their legs in response to moving their head forward, chin towards their chest?
Brudzinki's sign
What is the physical exam finding that illicits pain and forward bending of the neck when the knee is straightened from a bent position to a straight one?
Kernig's sing
What are kernig's and brudzinki's signs indicative of?
Meningial irritation (and possible meningitis)
How is the glass test used for rash differentiation in meningitis?
Place a clear glass or tumbler over the pt's rash with pressure.
- If the rash is meningitis related, it will not disappear
- If the rash is due to something else, the pressure will cause the redness/rash to disappear
How do you diagnose meningitis?
1. good H&P
2. Labs and cultures
3. LP (usually definitive)
4. can add imaging if previous inconclusive
How many tubes are collected during a lumbar puncture and what are each of them for?
4 tubes:
1. Chemistry
2. Hematology (cell count w/ diff)
3. Microbiology/immunology
4. Hold for repeat cell count if needed
What studies are completed on tube 3 of a lumbar puncture?
- Gram stain
- Bacterial culture
- Acid-Fast stain w/ TB cultures
- India ink stain (cryptococcus)
- Fungal cultures
What two etiologies of meningitis will cause the CSF to appear unclear?
- Bacterial (turbid appearance)
- TB (opaque with cobweb appearance)
What is another name for viral meningitis?
Aseptic meningitis
How do you treat viral meningitis?
Self limited
- typically will pass in 7-10 days - no anti-virals needed
How do you treat bacterial meningitis?
- Requires broad spectrum IV abx (which one depends on age)
- aggressive supportive therapy
- +/- dexamethasone
*This is life threatening
What are the complications from meningitis?
Can be severe; if caught early may be absent
- Seizures or other neurological deficits such as:
Hearing loss
Memory difficulty
Kidney failure
Death
When should prophylactic treatment be given to a patient for meningitis?
Pts who have come in close contact with someone with a meningococcal infection
- within 3 ft of infected person
- droplet exposure within 7 days of symptom onset
What is the only preventative treatment available for meningitis?
immunizations
What is encephalitis?
Inflammation of the brain
What is the most common cause of encephalitis?
Viral etiology
- HSV Type 1 specifically
What are the arboviruses that can cause encephalitis?
- Mosquito borne illness (west nile)
- Tick borne illness (powassan virus)
- Rabies virus
What are risk factors associated with encephalitis?
- Age
- Un-vaccinated
- Region
- Season
- Immunocompromised
How do you differentiate encephalitis vs. meningitis?
- Pure encephalitis will not present with nuchal rigidity, brudzinki's or kernig's
- Meningitis will not present with AMS or neurological deficits
- Both can occur at the same time and present with all S/S in meningoencephalitis
What is the treatment for encephalitis?
Anti-virals
- once cause is determined
Remove the cause if it is due to non-infectious cause

Severe cases should be admitted
What are some complications that can occur from encephalitis?
- Neurological deficits
Hearing or vision loss
Memory deficit
Personality changes
Motor function impairments
(etc)
What follow up care is typically needed for a pt recovering from encephalitis?
PT
OT
Speech therapy
Psychotherapy (coping strategies)
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