ID - HA/Fever

Classic Meningitis triad

HA, Fever, Stiff Neck

Petechiae

< 2mm

Purpura

> 2mm

Study of choice for menigits

CSF

When should you get a CT before the LB?

Hx of CNS dx

New onset seizure

ABN LOC

Neuro deficits

Papilledema

Most common bacterial meningitis

S. pneumoniae

Empiric treatment for bacterial meningitis

Dexamethasone first

-Ceftriaxone and Vanco

0-1 mo old with menigitis

Cover GBS

Amp + 3rd gen (cefotaxamime)

Amp + aminoglycoside

What should we avoid in babies because it makes them jaundice

Ceftriaxone

Bacterial menigitis > 50/IC treatment

Amp + 3rd gen ceph + Vanco

Neisseria/Menigococcal menigitis tx

??

Prophylaxis for menigiits (kids in class have it)

Rifampin

Determine how close the student was sitting

Low sugar in CSF

Positive lympocytes

Cough, night sweats, weight loss

TB menigitis

Young baby with.a bulging fontanelle, setting sun sign, +/- serizure

GBS meningitis

Post splenectomy patient, petechial rash, bactermiae, CSF APPEARS NORMAL

Menigococcemia

Water-Friderichsen syndrome

Adrenal infraction leading to adrenal insuff from Menigococcemia

Adrenal infraction leading to adrenal insuff from Menigococcemia

Water-Friderichsen syndrome

Go over CSF findings chart

**

MC viral meningitis

Enterovirus

Abdomnal sxs, maculopapular rash

Enterovirus meningitis

Enterovirus meningitis - rash seen

maculopapular rash

Definitive dx of Viral Meningitis

PCR of viruses of CSF

Tx of viral meningitis

Supportive

NO ABX

Rash on hands and feet, CSF has lymphocytes

Coxsackie

Common in patients with AIDS/IC

Cryptococcal meningitis

Cryptococcal meningitis - concern

pressure is very high - usu CT first

India ink shows multiple round organisms with a clear halo

Cryptococcal meningitis

Tx of Cryptococcal meningitis

Ampho B

Eosinophils in LP

Aseptic meningitis 2/2 NSAIDS

MCC of encephalitis

viral

Main sx of Herpes Simplex Encephalitis

AMS

Fever, HA, seizures, AMS in a young adult could be

Herpes Simplex Encephalitis

MC viral encephalitis in young adults

Herpes Simplex Encephalitis

CT shows low density areas with mass effect localixed to the temporal lobe

Herpes Simplex Encephalitis

What does herpes love

the TEMPORAL lobe

Herpes Simplex Encephalitis - DX of choice

PCR of CSF

Herpes Simplex Encephalitis - Tx

Acyclovir. - Start ASAP

MCC of childhood encephalitis

Enterovirus encephalitis

Baby with seizures and AMS

Enterovirus encephalitis

Types of Rabies

Encephalitic

Paralytic

Which type of rabies has hydrophobia

Encephalitic

Negri bodies seen....

Rabies

Primary reservoirs for Rabies

Bats, racoons, skunks, foxes

Tx rabies

Rabies Ig /vax

Brain abscess - MC in patients with a hx of

Sinus infection

Dental infection

Facial cellulitis

MCC of brain abscess

Spread from uncontrolled infection of sinus, middle ear, mastoid cells, and teeth

Classic triad of brain abscess

fever

HA

focal neuro deficits

fever

HA

focal neuro deficits

Brain abscess

Face swollen and red w fever and HA

Brain abscess

CT shows ring enhancing lesion

Brain abscess

What is more sensative for brain abscess CT or MRI

MRI (with contrast)

Tx for brain abscess

METRO IV 4-8 weeks

Increased ICP with papilledema, otherwise negative findings

Idiopathic intracranial HTN

Idiopathic intracranial HTN aka

psuedotumor cerebri

Tx for Idiopathic intracranial HTN

LP drainage, Lasix

Gram + diplo

S.pnuemo

G - diplo

Neisseria

Unconscoius family and cat

Carbon monoxide

MCC of acute poisoing death

Carbon monoxide

India ink is used for

Cryptococcus

Pressure of LP very high with

Crypto/fungal

Lymphocytes + low sugar

TB, Listeria, Fungal, Syphilis