Term
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Definition
| inflammation of the meninges of the brain or spinal cord |
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Term
T/F
Meningitis may become evident over hours or days (acute) or a longer period (subacute or chronic). |
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Definition
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Term
| What are the most common types of acute meningitis? |
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Definition
| acute bacterial meningitis and aseptic meningitis |
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Term
T/F
Aseptic meningitis is milder and typically self-limited. |
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Definition
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Term
| What is the classic meningitis triad? |
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Definition
| fever, headache, and nuchal rigidity |
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Term
| In meningitis with nuchal rigidity, which motion is most painful? |
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Definition
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Term
| What is Brudzinski's sign? |
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Definition
Passive neck flexion induces flexion of hip or knee
Seen in severe cases of nuchal rigidity |
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Term
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Definition
resistance to passive extension of the knee while the hop is flexed
Seen in severe cases of nuchal rigidity |
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Term
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Definition
| meningeal signs - neck stiffness, Burdzinski's and Kernig's signs |
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Term
| Why do meningeal signs or meningismus occur? |
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Definition
| because tension on nerve roots passing through inflamed meninges causes irritation |
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Term
T/F
Brain parenchyma is typically involved early in meningitis. |
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Definition
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Term
| What are the signs and symptoms that brain parenchyma is involved in meningitis? |
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Definition
| lethargy, confusion, seizures, and focal deficits |
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Term
| When does brain parenchyma become involved in meningitis? |
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Definition
| may become involved in untreated bacterial meningitis |
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Term
| When should a CT be run before lumbar puncture? |
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Definition
| patients with signs compatible with a mass lesion (focal deficits, papilledema, deterioration in consciousness, seizures) must have a CT before LP because of possibility of increased intracranial pressure |
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Term
| What is the most common cause of bacterial meningitis within the first 2 months of life? |
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Definition
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Term
| What are the top 2 causes of bacterial meningitis after the first 2 months of life? |
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Definition
| Nisseria meningitidis (meningococci) and Streptococcus pneumoniae (pneumococci) |
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Term
T/F
Meningococci (Neisseria meningitidis) exist in the nasopharynx of about 5% of people. |
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Definition
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Term
| In what populations is meningococcal (Neisseria meningitidis) most likely to occur? |
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Definition
| Those in the first year of life and in closed populations - military barracks, college dormitories, boarding schools, etc. |
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Term
| What is the predominant cell type in bacterial or other purulent meningitis? |
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Definition
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Term
| What are the abnormalities of the CSF in bacterial meningitis? |
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Definition
Pressure >300
100-10,000 cells
predominantly PMNs
glucose >25
Protein >100 |
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Term
| What are the normal CSF values for pressure, cells, cell type, glucose, and protein? |
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Definition
Pressure 100-200 mm H2O
0-5 Cells
Cell type: lymphocytes
glucose of 50-100
protein of 20-45 |
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Term
| What are the abnormalities of the CSF in aseptic meningitis? |
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Definition
Normal or inc. pressure
10-1,000 cells
Lymphocytes (sometimes some PMNs)
Normal glucose
Normal or inc. protein (< 100) |
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Term
| What are the abnormalities of the CSF in subacute or chronic meningitis? |
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Definition
Normal or inc. pressure
25-2,000 cells
cell type: lymphocytes
dec. glucose
inc. or greatly inc. protein |
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Term
| What is the most common cause of bacterial meningitis in adults? |
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Definition
| Pneumococci (Strep. pneumoniae) |
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Term
| Name some populations that are especially at risk for bacterial meningitis. |
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Definition
| alcoholics and people with chronic otitis, sinusitis, mastoiditis, CSF leaks, recurrent meningitis, pneumococcal pneumonia, sickle cell disease, or asplenia |
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Term
| When is Gram negative meningitis most likely to occur? |
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Definition
| in immunocompromised patiens or after CNS surgery, CNS trauma, bacteremia, or hospital acquired infections |
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Term
| What are the 4 routes of attack for bacterial meningitis? Notes |
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Definition
| colonization of the nasopharynx, bacteremia, via contiguous structure, and direct implantation |
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Term
| What is the most common cause of bacterial meningitis in patients <1 month old? Notes |
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Definition
|
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Term
| What is the most common cause of bacterial meningitis in those 2-18? Notes |
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Definition
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Term
| What is the most common cause of bacterial meningitis in those > 19? Notes |
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Definition
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Term
| What is the pathophysiology of meningitis? Why is it a problem? Notes |
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Definition
| Meningitis causes cerebral edema, which causes increased intracranial pressure. This pressure alters blood flow and causes neuronal injury. |
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Term
| Which 2 groups are exceptions to the typical clinical presentation for meningitis? Notes |
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Definition
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Term
| What % of patients present with < 24 hours duration and rapidly progressive signs? Notes |
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Definition
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Term
| How long does subacute meningitis have signs and symptoms for? Notes |
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Definition
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Term
| What is the mortality rate for meningitis? Notes |
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Definition
| ranges between 5-30% depending on the type |
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Term
| What things might a meningitis case present with? Notes |
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Definition
| sudden onset of fever, nausea, vomiting, headache, dec ability to concentrate, and myalgia. Sickest ever felt. Petechiae, low BP, inc heart rate |
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Term
| What % of meningitis cases present with headache? Notes |
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Definition
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Term
| What % of meningitis cases present with fever? Notes |
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Definition
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Term
| What % of meningitis cases present with meningisimus? Notes |
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Definition
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Term
| What % of meningitis cases present with Brudzinski's or Kernig's sign? Notes |
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Definition
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Term
| What % of meningitis cases present with altered sensorium? Notes |
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Definition
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Term
| What % of meningitis cases present with petechiae? Notes |
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Definition
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Term
T/F
Less than 1% of meningitis cases present with papilledema.
Notes |
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Definition
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Term
| Which causative agent for meningitis is associated with petechiae? Notes |
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Definition
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Term
| What lab tests would you want to run on a suspected meningitis patient? Notes |
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Definition
| CBC, WBC, Gram Stain, Na+, Clotting indices, blood cultures, X-ray, CT, CSF |
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Term
| How quickly do we want to begin treatment after seeing a patient with suspected meningitis? Notes |
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Definition
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Term
| What x-rays do you want to get in suspected meningitis cases? Notes |
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Definition
x-rays looking for a possible original infection - based off history
sinuses, mastoids, chest |
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Term
| When do you get a CT on a patient with suspected meningitis? Notes |
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Definition
| When there are focal neurological signs or papilledema |
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Term
| Which cranial nerves are most likely to be affected by meningitis? Notes |
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Definition
| 3 and 6 - which cause eye movement issues |
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Term
| What is the normal CSF opening pressure? Notes |
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Definition
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Term
| What is typically the opening pressure of someone with bacterial meningitis? Notes |
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Definition
|
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Term
| What is the cell count in the CSF of bacterial meningitis? Notes |
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Definition
typically 1,000-5,000
may be <100 - >10,000 |
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Term
| What is the cell count in the CSF of aseptic meningitis (viral)? Notes |
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Definition
typically 100-500
may be <10 to >1,000 |
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Term
T/F
The protein level in the CSF easily differentiates bacterial from aseptic meningitis. Notes |
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Definition
False
Both have protein levels generally 100-500
bacterial may occasionally have >1,000 |
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Term
| What type of stain looks for fungi? Notes |
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Definition
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Term
| What is cytology of the CSF looking for? Notes |
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Definition
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Term
| What does wet mount of the CSF look for? Notes |
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Definition
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Term
| What does C-reactive protein level of the CSF tell us? Notes |
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Definition
inflammation
usually + in bacterial and - in aseptic meningitis |
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Term
T/F
Bacterial meningitis causes a low glucose level in the blood. |
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Definition
| False - it's low in the CSF |
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Term
| How do you treat bacterial meningitis? Notes |
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Definition
|
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Term
| How do you treat bacterial meningitis empirically? Notes |
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Definition
<3 mos: Ampicillin + Cefotaxime
3 mos-18 years: Vancomycin + Cefotaxime/Ceftriaxone
18-50 years: vancomycin + ceftriaxone/cefotaxime
>50 years: ampicillin + vancomycin + cefotaxime/ceftriaxone |
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Term
| Name 5 predictors of poor prognosis in bacterial meningitis. Notes |
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Definition
| coma, high bacterial counts, low WBC counts, glucose <13 mg/dL, lactate >10 mEq/L |
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Term
| Name 4 potential sequelae from bacterial meningitis. Notes |
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Definition
| mental retardation/cognitive impairment, deafness, cranial and peripheral nerve abnormalities, seizures |
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Term
| What drugs are used as chemoprophylaxis against bacterial meningitis? Notes |
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Definition
Rifampin - 2 day PO tx
ceftriaxone - single IM dose, not <15 yrs
OR
ciprofloxacin - single PO dose (do not use in pregnant women or those under 18) |
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