Term
| What part of the body is usually involved with encephalitis? |
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Definition
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Term
| What is the leading cause of encephalitis? |
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Definition
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Term
| How does encephalitis generally present? |
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Definition
Can have viral prodrome (fever, malaise, body aches) and may develop confusion, seizures, and focal neurologic deficits (weakness, Cranial nerve sensory deficits).
Think HSV specifically when patients present with bizarre behavior, speech disorders, gustatory or olfactory hallucinations, or acute hearing impairment. |
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Term
| What other presenting symptoms can be seen when meningoencephalitis is present? |
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Definition
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Term
| How is encephalitis diagnosed? |
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Definition
| Clinical exam, CFS studies (PCR and HSV culture). MRI will show characteristic pattern in the temporal lobes, usually bilaterally. |
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Term
| How do you treat HSV encephalitis? |
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Definition
| Treat empirically with IV acyclovir. |
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Term
| When do you suspect West Nile Encephalitis and what are the primary symptoms? |
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Definition
| Anyone with acute febrile illness in late spring, early autumn. Patients may also have a maculopapular rash, flaccid paralysis suggestive Guillain-Barré syndrome. |
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Term
| How do you diagnose West nile encephalitis? |
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Definition
| CSF findings resemble those of viral meningitis. Test Serum or CSF by ELISA for IgM antibody to West Nile virus or a rise in IgG titer. |
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Term
| How do you treat west nile encephalitis? |
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Definition
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Term
| 33 yo man with HIV/AIDS and a CD 4 count of 20 is admitted to the ER with a 12hr history of fever, photophobia, headache. A major trauma has just arrived as well, so his LP was delayed by two hours. What medications should the patient be given before the LP is performed? |
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Definition
| Vancomycin, ampicillin, Cefepime, and dexamethasone (10 min before antibiotics) You are covering for G+ and G- organisms. Dexamethasone can be dc'd if not streptococcus pneumoniae on G-stain. |
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Term
| Most common bacterial source for meningitis in neonates (0-4wks)? |
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Definition
| Group B Strep, E. coli, Listeria |
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Term
| Most common bacterial source for meningitis in infants (1-23 mo)? |
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Definition
| Streptococcus pneumoniae, Nisseria meningitidis, Haemophilus influenzae. |
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Term
| Most common bacterial source for meningitis in age 2-50 years? |
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Definition
| S. Pneumoniae, N meningitidis |
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Term
| Most common bacterial source for meningitis in the elderly? |
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Definition
| S. Pneumoniae, N. Mengitidis, Listeria monocytogenes |
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Term
| What are the symptoms of bacterial meningitis? |
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Definition
Fever, malaise, headaches, photophobia, neck stiffness, +/- nausea and vomiting. Fundoscopic exam may show papilledema.
Look for nucal rigidity and Kernig's or Brudzinski's sign. |
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Term
| How do you diagnose bacterial meningitis? |
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Definition
| LP in any patient that is suspected. If papilledema or other signs of increased ICP, get head CT prior to LP. |
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Term
| What is the opening pressure, cell type, glucose, and protein levels in bacterial meningitis? |
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Definition
200-500
PMNs
Low Glucose
High Protein |
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Term
| What is the opening pressure, cell type, glucose, and protein levels in viral meningitis? |
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Definition
<250
Lymphocytes
Normal glucose
Normal protein |
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Term
| What is the opening pressure, cell type, glucose, and protein levels in TB meningitis? |
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Definition
180-300
Lymphocytes
Low to normal glucose
Normal to High protein |
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Term
| How do you treat S. Pneumonia meningitis? |
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Definition
| Vancomycin + third generation cephalosporin +/- Dexamethasone |
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Term
| How do you treat N. meningitidis meningitis? |
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Definition
| Ampicillin or 3rd gen cephalosporin |
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Term
| How do you treat L monocytoges meningitis? |
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Definition
| Ampicillin (NOT CEPHALOSPORINS) |
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Term
| How do you treat Streptococcus agalactiae meningitis? |
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Definition
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Term
| How do you treat H. influenzae type b meningitis? |
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Definition
| 3rd Generation cephalosporin |
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