Medicine 5th year, 5th lecture/part two (Dr. Mohammed Tahir)

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The lecture has been given on May 21st, 2011 by Dr. Mohammed Tahir.

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Medicine 5th year, 5th lecture/part two (Dr. Mohammed Tahir)

  1. 1. CNS Infections
  2. 2. CNS Infections <ul><li>Meningitis </li></ul><ul><ul><li>Bacterial </li></ul></ul><ul><ul><li>Viral </li></ul></ul><ul><ul><li>Fungal </li></ul></ul><ul><ul><li>Chemical </li></ul></ul><ul><ul><li>Carcinomatous </li></ul></ul>
  3. 3. <ul><li>Encephalitis </li></ul><ul><ul><li>Bacterial </li></ul></ul><ul><ul><li>Viral </li></ul></ul><ul><li>Meningoencephalitis </li></ul><ul><li>Abscess </li></ul><ul><ul><li>Parenchymal </li></ul></ul><ul><ul><li>Subdural </li></ul></ul><ul><ul><li>Epidural </li></ul></ul>
  4. 4. Bacterial Meningitis <ul><li>Streptococcus pneumoniae </li></ul><ul><li>Niesseria meningitidis </li></ul><ul><li>Hemophilus influenzae </li></ul><ul><li>Listeria moncytogenes </li></ul><ul><li>Group B streptococcus </li></ul>
  5. 5. Bacterial causes of meningitis <ul><li>L monocytogenous </li></ul><ul><li>T.B </li></ul><ul><li>Crypto </li></ul><ul><li>N-Meningitidis </li></ul><ul><li>St-pneumonia </li></ul><ul><li>Older child </li></ul><ul><li>Less common </li></ul><ul><li>Common </li></ul><ul><li>Age of onset </li></ul><ul><li>L monocytogenous </li></ul><ul><li>T.B </li></ul><ul><li>Crypto </li></ul><ul><li>St-pneumonia </li></ul><ul><li>N-Meningitidis </li></ul><ul><li>Adult </li></ul><ul><li>Mycobacterium </li></ul><ul><li>tuberculosis </li></ul><ul><li>H-influenzae </li></ul><ul><li>N-meningitidis </li></ul><ul><li>St-pneumonia </li></ul><ul><li>Pre-school child </li></ul><ul><li>Listeria monocytogenes </li></ul><ul><li>G-ve bacillia </li></ul><ul><li>Group B streptococci </li></ul><ul><li>Neonate </li></ul>
  6. 6. Bacterial Menigitis <ul><li>Age less than 3 months </li></ul><ul><ul><li>Group B strep </li></ul></ul><ul><ul><li>- E. coli </li></ul></ul><ul><ul><li>L. Monocytogenes </li></ul></ul><ul><ul><li>- Strep. pneumoniae </li></ul></ul>
  7. 7. Bacterial Meningitis <ul><li>3 Months to 1 year </li></ul><ul><ul><li>S. pneumoniae </li></ul></ul><ul><ul><li>H. influenzae </li></ul></ul><ul><ul><li>N. meningitidis </li></ul></ul>
  8. 8. Bacterial Meningitis <ul><li>Age 18 to 50 years </li></ul><ul><ul><li>S. pneumoniae </li></ul></ul><ul><ul><li>N. meningitidis </li></ul></ul><ul><ul><li>H. influenzae </li></ul></ul>
  9. 9. Bacterial Meningitis <ul><li>Over age 50 years </li></ul><ul><ul><li>S. pnemoniae </li></ul></ul><ul><ul><li>L. monocytogenes </li></ul></ul><ul><ul><li>Gram (-) bacilli </li></ul></ul>
  10. 10. <ul><li>Symptoms </li></ul><ul><ul><li>Fever (hypothermia in children) </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>lethargy to coma </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>- Constitutional symptoms </li></ul></ul>
  11. 11. <ul><li>Signs </li></ul><ul><ul><li>Altered mental status (lethargy to coma). </li></ul></ul><ul><ul><li>Meningeal signs (neck stiffness, kering sign and brudzinski sign). </li></ul></ul><ul><ul><li>- Focal neurological signs. </li></ul></ul><ul><ul><li>Increased intracranial pressure ( papilledema, nausea/vomiting, abducens palsies, bulging fontanelle in infants </li></ul></ul><ul><ul><li>- Skin rash. </li></ul></ul><ul><ul><li>- Adrenal insufficiency. </li></ul></ul><ul><ul><li>- Signs of systemic diseases. </li></ul></ul>
  12. 12. LP <ul><li>glucose and protein </li></ul><ul><li>cell count and differential </li></ul><ul><li>gram stain and rountine culture </li></ul><ul><li>Cyrptococcal antigen </li></ul><ul><li>AFB stain and culture </li></ul><ul><li>VDRL, or viral studies (PCR) </li></ul>
  13. 13. CSF Characteristics 500-1000 <50 <200 1000-10000 Wbcs (c/mm3) None None None Few Rbcs Very High High Normal Very high Pro Low Low Normal Very Low Glu Ususally high Normal or High Slightly elevated Elevated Opening Pressure TB Fungal Viral Bacterial
  14. 14. Treatment of Bacterial Meningitis <ul><li>3 rd generation cephalosporin </li></ul><ul><li>Steroids – Dexamethasone IV q6 for 4 days </li></ul><ul><li>Antpyertic </li></ul><ul><li>Treatmebt of seizure </li></ul><ul><li>Treatment of complications </li></ul>
  15. 15. Viral Meningitis <ul><li>More common </li></ul><ul><li>Viruses: Enteroviruse,Mumps, </li></ul><ul><li>Influenza Herpes simplex </li></ul><ul><li>Treatment is supportive </li></ul>
  16. 16. Viruses causing acute encephalitis <ul><li>Common </li></ul><ul><li>Arboviruses </li></ul><ul><li>Enterovirsuses </li></ul><ul><li>HSV </li></ul><ul><li>Less common </li></ul><ul><li>CMV </li></ul><ul><li>EBV </li></ul><ul><li>HIV </li></ul><ul><li>Mumps </li></ul>
  17. 17. Viral Encephalitis <ul><li>Encephalitis (Meningoencephalitis) </li></ul><ul><ul><li>Altered mental status, fever, focal deficit and seizures </li></ul></ul><ul><ul><li>Herpes Simplex virus (catastrophic condition) predictable to the medial temporal lobe </li></ul></ul><ul><ul><ul><li>Acyclovir (30-60mg/dl) </li></ul></ul></ul><ul><ul><ul><li>Management of seizures </li></ul></ul></ul><ul><ul><ul><li>Very high morbidity and mortality </li></ul></ul></ul><ul><ul><ul><li>PCR diagnosis of CSF </li></ul></ul></ul>
  18. 18. Chronic & recurrent meningitis <ul><li>Characteristic neurological syndrome for>4weeks with </li></ul><ul><li>Persistent inflammation in CSF (WBC>5/Ul) </li></ul><ul><li>Causes:1-Meningeal infection (Immunocompromised patients) </li></ul><ul><ul><li>Cryptococcus neoformans </li></ul></ul><ul><ul><li>HIV </li></ul></ul><ul><ul><li>M. tuberculosis </li></ul></ul><ul><ul><li>M. avium </li></ul></ul><ul><ul><li>2-Malignancy (Carcinomatous meningitis) </li></ul></ul><ul><li>Lung, breast </li></ul><ul><ul><li>3 -Noninfectious inflammatory disorder </li></ul></ul><ul><li>4-Chemical meningitis </li></ul><ul><li>5-Parameningeal infections </li></ul>
  19. 19. Symptoms & signs of sub acute and chronic meningitis <ul><li>Symptom Sign </li></ul><ul><li>Chronic headache Sign of Meningeal irritation </li></ul><ul><li>Change in personality Altered mental status </li></ul><ul><li>Facial weakness Crainal nerve palsy </li></ul><ul><li>Double visions Papilledema,optic atrophy </li></ul><ul><li>Weakness Myelopathy,radiculopathy </li></ul><ul><li>Sensory symptoms Frontal lobe dysfunction </li></ul><ul><li>Sphincter dysfunction Ataxia </li></ul>
  20. 20. TB Meningitis <ul><li>Meningitis of subacute onset </li></ul><ul><li>Fever, vomiting, drowsiness, illhealth, wt loss, anorexia, sweating and focal dificits </li></ul><ul><li>Meningeal signs, Papilodema and hyloid tubercule </li></ul><ul><li>antiTB </li></ul><ul><li>Steroid for 4wks </li></ul>

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