The document discusses meningitis, including its anatomy, causes, symptoms, diagnostic criteria, treatment, and nursing management. Meningitis is an inflammation of the protective membranes covering the brain and spinal cord known as the meninges, which can be caused by bacterial, viral, or fungal infections. Symptoms include headache, fever, and neck stiffness, while diagnosis involves lumbar puncture, CSF analysis, and neuroimaging.

1. MENINGITIS
Evaluator: Mr L Anand Presenter: Shruti Shirke
[Asso professor, CON AIIMS BBSR] M.Sc Neuroscience Nursing

2. ANATOMY

4. CSF
• 1dl of CSF
• 70% of lymphocytes
• 30% Monocytes
• Few Polymorph nuclear cells (Neutrophils)
• Proteins 15 – 50mg
• Glucose 45-100 mg (2/3 of blood glucose level)
• Pressure 200mmh2O (15mmhg)
• Total CSF 150ml
• 500ml CSF produced every day

7. DEFINITION – MENINGITIS
• Leptomeningitis, which is more commonly referred to as meningitis, represents
inflammation of the subarachnoid space (i.e. arachnoid mater and pia mater) caused
by an infectious or noninfectious process.

8. DEFINITION – ENCEPHALITIS

9. MENINGO-ENCEPHALITIS

10. INCIDENCE

11. CAUSES/RISK FACTORS
• Autoimmune disease
• Side effects to drugs (intrathecal therapy)
• Infection (most common)

13. CAUSATIVE ORGANISM
• Bacteria & virus – Acute meningitis
• Fungi – Chronic meningitis
• Streptococcus Pneumoniae (~50%)
• Neisseria meningitidis (~25%)
• Group B Spreptococci (~15%)
• Listeria monocytogenes (~10%)
• Hemophilus influenzae (<10%)
In Aseptic Meningitis the cause
is viral or secondary to
lymphoma, leukemia, HIV,
HSV, MUMPS, Varicella zoster,
Enterovirus
Fungi: Cryptococcus
genuses
Coccidioides genuses

14. COMMON CAUSATIVE
ORGANISMS
• Newborn: Group B Spreptococci, E. coli, Listeria
Monocytogenes
• Children & teens: Neisseria meningitides, Streptococcus
Pneumoniae
• Adult & elderly: Streptococcus Pneumoniae, Listeria
Monocytogenes
• Tick borne causes: borrelia Burgdorferi (lyme disease)
• Tubercular meningitis: Mycobacterium tuberculosis
• Parasitic meningitis: P. Falciparum

15. DIRECT SPREAD
• Anatomical congenital
defect: Spine bifida
• Acquired congenital defect:
CSF leak, skull fracture
HAEMATOGENOUS
SPREAD
• URTI
• Infective endocarditis
• Other systemic infections

16. SIGN & SYMPTOMS
• Classical triad
Headaches
Fever
Nuchal rigidity

18. SIGN & SYMPTOMS
• Photophobia
• Phono-phobia
• Altered mental status
• Seizures
Meningo-encephalitis

19. SIGN & SYMPTOMS
• Other symptoms can include nausea, vomiting,
photalgia (photophobia), sleepiness, confusion,
irritability, delirium, and coma. Patients with viral
meningitis may have a history of preceding systemic
symptoms (eg, myalgias, fatigue, or anorexia).

20. SIGN & SYMPTOMS
• Infants may have the following:
• Bulging fontanelle (if euvolemic)
• Paradoxic irritability (ie, remaining quiet when stationary and
crying when held)
• High-pitched cry
• Hypotonia

22. PHYSICAL EXAMINATION
• The examination should
evaluate the following:
• Focal neurologic signs
• Signs of meningeal irritation
• Systemic and extracranial
findings
• Level of consciousness
• In chronic meningitis, it is
essential to perform careful
general, systemic, and
neurologic examinations,
looking especially for the
following:
• Lymphadenopathy
• Papilledema
• Meningismus
• Cranial nerve palsies
• Other focal neurological signs

23. DIAGNOSTIC CRITERIA
• Clinical signs:
• Kernig sign
• Nuckle rigidity
• Jolt maneuver
• Brudzinski sign

25. DIAGNOSTIC CRITERIA
• Bacterial culture, gram staining of CSF and blood are key diagnostic
tests.
• Gram stain of CSF reveals organism in 70-80% of cases.
• Serum lactic dehydrogenase (LDH) help to differentiate bacterial
form viral infections.
• CBC
• Routine investigations

26. LUMBAR PUNCTURE / CSF
ANALYSIS

27. CSF ANALYSIS (BACTERIAL)

28. CSF ANALYSIS (TB)

29. CSF ANALYSIS (VIRAL)

30. DIAGNOSTIC CRITERIA
• PCR: HIV, Enterovirus, HSV, Tuberculosis.
• Western blot test: Borrelia brugdoferi
• Blood smear for malaria
• ANCA/ANA

31. NEUROIMAGING (CT OF THE
HEAD OR MRI OF THE BRAIN)
• CT
• may be normal
• subtle hydrocephalus
• hyperdensity around basal cisterns
(especially in tuberculosis)
• leptomeningeal enhancement
• complications or sources of the meningitis
• MRI
• T1: may be normal; sulci may appear less
hypointense than normal
• T1 C+ (Gd): leptomeningeal enhancement
• FLAIR: demonstrates hyperintense signal in
CSF space, especially in the sulci
• FLAIR C+ (Gd): has shown to be more
sensitive and specific than T1 C+ (Gd)
sequence in spotting leptomeningeal
enhancement
• MR angiography: arterial narrowing or
occlusion

32. CT FINDING IN
MENINGITIS
Acute bacterial
meningitis. This axial
nonenhanced computed
tomography scan shows
mild ventriculomegaly
and sulcal effacement.

34. TREATMENT
• Prompt initiation of empiric antibacterial therapy as
appropriate for patient age and condition
• After identification of the pathogen and determination of
susceptibilities, targeted antibiotic therapy as appropriate for
patient age and condition
• Steroid (typically, dexamethasone) therapy
• In certain patients, consideration of intrathecal antibiotics.

35. MANAGEMENT
• Fungal meningitis - Cryptococcal (amphotericin B, flucytosine,
fluconazole), Coccidioides immitis (fluconazole, amphotericin B,
itraconazole), Histoplasma capsulatum (liposomal amphotericin B,
itraconazole), or Candida (amphotericin plus 5-flucytosine)
• Tuberculous meningitis (isoniazid, rifampin, pyrazinamide, ethambutol,
streptomycin)
• Lyme meningitis (ceftriaxone; alternatively, penicillin G, doxycycline,
chloramphenicol)

36. MANAGEMENT
• Dexamethasone has been shown to be beneficial ,if it is
administered 15-20 minutes before the first dose of antibiotic and
every 6 hours for next 4 days.
• Dehydration and shock are treated with fluid volume expanders.
• Seizure which may occur early in the outcome of the disease, are
controlled with phenytoin (Dilantin).

37. MANAGEMENT

38. NURSING INTERVENTIONS
• Monitor vital signs and neurological signs.
• Assess for signs of increasing ICP.
• Initiate seizure precautions.
• Monitor for seizure activity.
• Monitor for signs of meningeal irritation.
• Perform cranial nerve assessment.
• Assess peripheral vascular status.
• Maintain isolation precautions as necessary with bacterial meningitis.
• Maintain urine and stool precautions with viral meningitis.
• Maintain respiratory isolation for the client with pneumococcal meningitis.
• Elevate the head of the bed 30 degrees, and avoid neck flexion and extreme hip flexion.
• Prevent stimulation and restrict visitors.
• Administer analgesics as prescribed.
• Administer antibiotics as prescribed.

39. • Physiological response: Neurological examination; vital signs;
presence of fever; adequacy of airway, breathing, and
circulation
• Fluid and electrolyte balance: Intake and output, body weight,
skin turgor, abnormal serum electrolytes
• Complications: Seizure activity, decreased mental status,
fever, increased ICP

40. DISCHARGE AND HOME
HEALTHCARE GUIDELINES
• Explain all medications and include the mechanism of action, dosage, route, and side
effects.
• Explain any drug interactions or food interactions.
• Instruct the patient to notify the primary healthcare provider for signs and symptoms
of complications, such as fever, seizures, developmental delays, or behavior changes.
• Provide referrals and teaching specific to the identified neurological deficits.
• Encourage the parents to maintain appropriate activities to facilitate the growth and
development of the child.

41. BRAIN ABSCESS
S H R U T I S H I R K E

42. DEFINITION
• A brain abscess is a collection of infectious material within the
tissue of the brain.
• Brain abscess is a focal area of necrosis with a surrounding
membrane within the brain parenchyma, usually resulting from an
infectious process or rarely from a traumatic process.