medicine.Cns infections 1.(dr.muhamad tahir)

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medicine.Cns infections 1.(dr.muhamad tahir)

  1. 1. CNS Infections
  2. 2. CNS Infections Meningitis – Bacterial – Viral – Fungal – Chemical – Carcinomatous
  3. 3.  Encephalitis – Bacterial – Viral Meningoencephalitis Abscess – Parenchymal – Subdural – Epidural
  4. 4. Bacterial Meningitis Streptococcus pneumoniae Niesseria meningitidis Hemophilus influenzae Listeria moncytogenes Group B streptococcus
  5. 5. Bacterial causes of meningitisAge of onset Common Less commonNeonate G-vebacillia Listeria monocytogenes Group B streptococciPre-school child H-influenzae Mycobacterium N-meningitidis tuberculosis St-pneumoniaOlder child N-Meningitidis L monocytogenous St-pneumonia T.B CryptoAdult St-pneumonia L monocytogenous N-Meningitidis T.B Crypto
  6. 6. Bacterial Menigitis Age less than 3 months – Group B strep - E. coli – L. Monocytogenes - Strep. pneumoniae
  7. 7. Bacterial Meningitis 3 Months to 1 year – S. pneumoniae – H. influenzae – N. meningitidis
  8. 8. Bacterial Meningitis Age 18 to 50 years – S. pneumoniae – N. meningitidis – H. influenzae
  9. 9. Bacterial Meningitis Over age 50 years – S. pnemoniae – L. monocytogenes – Gram (-) bacilli
  10. 10.  Symptoms – Fever (hypothermia in children) – Headache – lethargy to coma – Nausea – Vomiting - Constitutional symptoms
  11. 11.  Signs – Altered mental status (lethargy to coma). – Meningeal signs (neck stiffness, kering sign and brudzinski sign). - Focal neurological signs. – Increased intracranial pressure ( papilledema, nausea/vomiting, abducens palsies, bulging fontanelle in infants - Skin rash. - Adrenal insufficiency. - Signs of systemic diseases.
  12. 12. LP glucose and protein cell count and differential gram stain and rountine culture Cyrptococcal antigen AFB stain and culture VDRL, or viral studies (PCR)
  13. 13. CSF Characteristics Bacterial Viral Fungal TBOpening Elevated Slightly Normal UsusallyPressure elevated or High highGlu Very Low Normal Low LowPro Very high Normal High Very HighRbcs Few None None NoneWbcs 1000-100 <200 <50 500-1000(c/mm3) 00
  14. 14. Treatment of Bacterial Meningitis 3rd generation cephalosporin Steroids – Dexamethasone IV q6 for 4 days Antpyertic Treatmebt of seizure Treatment of complications
  15. 15. Viral MeningitisMore common Viruses: Enteroviruse,Mumps, Influenza Herpes simplexTreatment is supportive
  16. 16. Viruses causing acute encephalitisCommonArbovirusesEnterovirsusesHSVLess commonCMVEBVHIVMumps
  17. 17. Viral Encephalitis Encephalitis (Meningoencephalitis) – Altered mental status, fever, focal deficit and seizures – Herpes Simplex virus (catastrophic condition) predictable to the medial temporal lobe  Acyclovir (30-60mg/dl)  Management of seizures  Very high morbidity and mortality  PCR diagnosis of CSF
  18. 18. Chronic & recurrent meningitisCharacteristic neurological syndrome for>4weeks withPersistent inflammation in CSF (WBC>5/Ul)Causes:1-Meningeal infection (Immunocompromised patients) – Cryptococcus neoformans – HIV – M. tuberculosis – M. avium 2-Malignancy (Carcinomatous meningitis) Lung, breast 3-Noninfectious inflammatory disorder 4-Chemical meningitis 5-Parameningeal infections
  19. 19. Symptoms & signs of sub acute and chronic meningitisSymptom SignChronic headache Sign of Meningeal irritationChange in personality Altered mental statusFacial weakness Crainal nerve palsyDouble visions Papilledema,optic atrophyWeakness Myelopathy,radiculopathySensory symptoms Frontal lobe dysfunctionSphincter dysfunction Ataxia
  20. 20. TB Meningitis Meningitis of subacute onset Fever, vomiting, drowsiness, illhealth, wt loss, anorexia, sweating and focal dificits Meningeal signs, Papilodema and hyloid tubercule antiTB Steroid for 4wks

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