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Meningitis
- 1. DR SURJEET ACHARYA RESIDENT Case Presentation FEVER + HEADACHE + DROWSINESS - DD AND APPROACH
- 2. This means underlying question
- 3. A 56 year old female was brought to the ED in BLS ambulance on stretcher accompanied by the EMT and patient relatives PRIMARY SURVEY Airway - Patent Breathing - RR - 20/min, SpO2 - 85 % on RA Circulation - PR - 86/min, BP - 90/60 mmHg Disability - B/L pupils NSNR GCS - E3 V1 M5 (9/15) Exposure - No active head injuries seen, no pungent smell, no other external injuries seen Started on oxygen @ 5L (face mask ) IVF - NS @ 80ml/hr
- 4. SAMPLE S/S - As per history by daughter, pt suddenly developed drowsiness with high grade fever 5-6 hours before ED arrival, pt was given over the counter medications by daughter but not relieved, hence brought to the ED. Allergy history - Not significant Medications history - under medication for diabetes and hypertension Past history - operated one year ago for base of skull meningioma, OPD visit for CSF rhinorrhea 3 months back Last meal - just before developing drowsiness Event prior to the presentation - patient took her diet and took her medications and suddenly developed drowsiness Menstrual history - attained menopause
- 5. SECONDARY SURVEY HEENT - NO PICCLES, neck rigidity present, tongue moist Chest - B/L AE present, wheeze present CVS - S1 S2 present CNS - Drowsy but arousable, irritable, no FND, tone - normal all 4 limbs, power cannot be tested, cerebellar signs could not be tested P/A - soft Spine - normal External genitalia - normal Kernig’s,Brudzi nki’s sign Nuchal rigidity Jolt accentuation
- 6. Repeat vitals - PR - 88/min BP - 100/70 mmHg SpO2 - 99 % RR - 20/min T - 100 * F D/D : Meningitis Encephalitis SAH / IC bleed Brain abscess
- 7. Investigation and Treatment Basic labs Special tests - Paired blood culture and sensitivity , LP NCCT Head MRI brain with contrast ANTIBIOTICS - EMPERICAL STAT DOSE Supportive therapy
- 8. DISPOSITION Patient admitted to ICU for further management
- 9. MENINGITIS Inflammation of the meninges is called as meningitis Q. What is encephalitis?
- 10. HSV - 1 AND 2, HZV, CMV, HIV, Rabies, Polio Strep pneumoniae, HiB, Neiserria, E.coli Cestodes, nematodes Crypto, candida Drugs - NSAID’s, Mdz
- 18. BACTERIAL MENINGITIS ROLE OF DEXAMETASONE????
- 19. VIRAL MENINGITIS
- 20. SUMMARY 1. Meningitis is inflammation of meninges, Encephalitis is inflammation of brain parenchyma 2. Clinical findings (special tests) are not always confirmatory for meningitis 3. LP is diagnostic test for identification of meningitis causative organisms 4. CT/MRI brain has little effect for diagnosis of meningitis but rules out other CNS cause 5. Mortality rate is low when diagnosed early and treated early and effectively
- 21. GIVE REST TO YOUR NECK ANY QUESTIONS????
- 22. Is this case of meningitis ???? (risk factors)
- 23. What type of meningitis is this???
- 26. Antibiotic of choice in this case ????