Neurologic Disorders: Infection, Tumor

Meningitis

• What it is

• Associated with

• How its diagnosed

• S/s

• Inflammation of meninges

• Hydrocephalus, venous thrombosis

• Lumbar puncture, MRI/CT

• Fever, headache, stiff neck, n/v, altered consciousness, focal CN signs, seizures

Are bacterial or viral more common for meningitis?

• Worse prognosis?

Viral (enteroviruses, herpes, epstein barr virus/mono)

• Bacterial (H Flu, pneumo/meningiococcus, TB)

Meningeal irritation tests (2)

• Kernig- post. thigh pain when passive hip flexion with knee extension

• Brudzinski- hip + knee flexion (automatic) when you passively flex the neck

Low _ can usually let us know it the meningitis is bacterial/fungal

glucose

Tx for meningitis?

Bacterial: antibiotics

Viral: antivirals or vaccines

Encephalitis

• What it is

• Associated with

• Sources of infection

• S/s

• Inflammation of the brain tissue (parenchyma)

• Brain edema, meningeal inflammation, cell death

• Herpes, insect borne, rabies, MMR, chickenpox, autoimmune, idiopathic

• Fever, headache, n/v, light/sound sensitivity, altered consciousness/coma, meningeal signs, focal neurologic signs, movement disorder

Encephalitis more for - matter than - matter

Gray, white

How can you evaluate encephalitis?

CBC, CSF, MR/CT, EEG, ICP monitoring

Tx for encephalitis?

Viral: antivirals

Bacterial: antibiotics

Autoimmune: immunotherapy

Brain Abscess

• What it is

• Associated with

• S/s

• Pus-filled pocket in the brain due to infection, focal

• Edema, increased ICP

• Headache, alterations in consciousness, focal neuro changes, fever, seizures, PROGRESSIVE SYMPTOMS

Evaluation of abscess?

MRI, CBC, EEG

Tx?

Bacterial: IV antibiotics, may need surgical decompression

Brain Tumors

• Generally a -/- site

• More benign in -, more malignant in -

• 2/3 - in adults, 2/3 - in kids (2nd leading cancer in kids)

• Secondary/metastatic

• AAs, white ppl

• Supratentorial, infratentorial

S/s of brain tumors?

Headache, seizure, n/v, mental status/behavorial/personality changes, focal neurological changes, papilledema

Primary brain tumor main types?

Gliomas, meningioma (common, benign, arachnoid, slow growing), pituitary adenoma, acoustic neuroma (benign, schwann cells of v. CN 8)

Gold standard to dx brain tumors?

MRI

Tx for brain tumor?

Surgery, radiation, chemo, steroids for swelling, seizure meds

What are common primaries for secondary brain tumor?

Lung, breast, GI, melanoma, renal

S/s of secondary brain tumors?

Frontal and parietal lobe changes (personality/mvmnt, spatial awareness/coordination), back pain, neurologic deficits/radicular pain

Diagnosis and tx for secondary BTs?

MRI, surgery/radiation/steroids