Cns Infection
Cns Infection
Cns Infection
INFECTIONs
Bernamieh Calam-Pastor, MD
CUMC LEVEL II- IM Resident
● MENINGITIS
● ENCEPHALITIS
● FOCAL INFECTIONS (e.g Brain
Abscess, Subdural Empyema)
Key goals
● Emergently distinguish
● Identify responsible pathogen
● Initiate appropriate antimicrobial therapy
Meningitis
ACUTE
- duration of < 5 days
- 75% of all community acquired meningitis cases
SUBACUTE
- 5 days or more
- comorbidities, immunosuppressed
CHRONIC
- >4 weeks duration
- broad differential diagnosis
Bacterial Meningitis
• Most common form of suppurative CNS infection
10%
15%
50%
S. pneumoniae N. meningitides
group B streptococci L. monocytogenes
Inflammatory reaction induced by the invading bacteria
NUCHAL
FEVER HEADACHE
RIGIDITY
BRUDZINSKI SIGN KERNIG SIGN
LUMBAR PUNCTURE
GOAL:
Begin antibiotic
within 60 min from
arrival in ER
Dexamethasone
- Giving 20min before antibiotic therapy
-> inhibits the production of TNF-α by macrophages and microglia
-decrease meningeal inflammation and neurologic sequelae
PROGNOSIS:
Immunocompromised patients
PROGNOSIS
In adults, the prognosis for full recovery
from viral meningitis is excellent.
TB Meningitis
A 6-month course of therapy is acceptable, but therapy should be prolonged for 9–12
months in patients who have an inadequate resolution of symptoms of meningitis or
who have positive mycobacterial cultures of CSF during the course of therapy
Encephalitis
ENCEPHALATIS
Inflammation of the brain
Encephalopathy
● diffuse cerebral dysfunction without associated inflammation of
brain tissue
● Most common causes: toxins and metabolic dysfunction
Clinical Manifestation
Aphasia
Ataxia
Upper and Lower Motor weakness
Involuntary movements
Cranial nerve deficits
Diagnostic goals:
Empiric Treatment:
Acyclovir 10mg/kg three times daily IV
Diagnostics
Neuroimaging
-assist in differentiation between a focal and diffuse encephalitic process
-MRI is more sensitive
CSF studies
-characteristics profile is indistinguishable from viral meningitis
-consists:
lymphocytic pleocytosis
mildly elevated protein concentration
normal glucose concentration
CSF PCR
- primary diagnostic test: HSV, CMV, EBV, HHV-6 and enteroviruses
Brain biopsy
Management
Seizures precautions
Prognosis
• difficulties in concentration
• behavioral and speech disorders
• memory loss
Age
Level of consciousness
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