This document discusses various central nervous system infections, including acute bacterial meningitis, viral meningitis, tuberculous meningitis, and viral encephalitis. It provides information on the epidemiology, clinical presentation, diagnosis, and treatment of these conditions. Key signs of meningeal irritation are discussed. Lumbar puncture is described as the gold standard diagnostic tool for meningitis, while PCR testing of CSF has become important for identifying viral etiologies. Rapid antibiotic treatment is essential for bacterial meningitis.
Consultant Paediatric Neurologist and senior lecturer at the Institute of Child Health, Dr Peta Sharples, then provided an in-depth look at the effects that meningitis has on the brain and an comprehensive overview on the rehabilitation of children who have had the disease.Dr Sharples' presentation emphisised another of the day's themes, the need for early recognition and treatment not only to save lives but to aid rehabilitation for survivors.
Consultant Paediatric Neurologist and senior lecturer at the Institute of Child Health, Dr Peta Sharples, then provided an in-depth look at the effects that meningitis has on the brain and an comprehensive overview on the rehabilitation of children who have had the disease.Dr Sharples' presentation emphisised another of the day's themes, the need for early recognition and treatment not only to save lives but to aid rehabilitation for survivors.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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3. Acute infections of the nervous system
early recognition, efficient decision making, and
rapid institution of therapy can be Lifesaving.
Including
Acute bacterial meningitis
Tuberculous meningitis
Viral meningitis
Encephalitis
Focal infections such as brain abscess
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4. APPROACH TO THE PATIENT
Nuchal rigidity ("stiff neck") is the
pathognomonic sign of meningeal irritation and
is present when the neck resists passive flexion
Kernig’s sign is elicited with the patient in the
supine position. The thigh is flexed on the
abdomen with the knee flexed; attempts to
passively extend the knee elicit pain when
meningeal irritation is present.
Brudzinski’s sign is elicited with the patient in
the supine position and is positive when passive
flexion of the neck results in spontaneous flexion
of the hips and knees. 4
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5. 5
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The sensitivity and specificity of Kernig’s and
Brudzinski's signs are uncertain.
Both may be absent or reduced in very young or
elderly patients, immunocompromised individuals, or
patients with a severely depressed mental status.
7. ACUTE BACTERIAL MENINGITIS
Definition
Acute purulent infection within the subarachnoid
space → may result in decreased consciousness,
seizures, raised intracranial pressure (ICP), and
stroke
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8. ACUTE BACTERIAL MENINGITIS
Epidemiology
Incidence in the US >2.5 cases /100,000 population.
Common causes of bacterial meningitis include :
Streptococcus pneumoniae , Neisseria meningitidis
, group B streptococci , Listeria monocytogenes ,
and Haemophilus influenzae type b
N. meningitidis (meningococcus) is the causative
organism of recurring epidemics of meningitis every
8 to 12 years.
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10. ACUTE BACTERIAL MENINGITIS
CLINICAL PRESENTATION
The classic clinical triad of meningitis is fever,
headache, and nuchal rigidity
A decreased level of consciousness occurs in >75% of
patients and can vary from lethargy to coma.
Nausea, vomiting, and photophobia are also common
complaints.
Seizures occur as part of the initial presentation of
bacterial meningitis or during the course of the illness
in 20-40% of patients.
Focal seizures are usually due to focal arterial
ischemia or infarction, hemorrhage, or focal edema
Generalized seizure activity and status epilepticus
may be due to hyponatremia, diffuse edema, cerebral
anoxia, or the toxic effects of antimicrobial agents
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11. ACUTE BACTERIAL MENINGITIS
CLINICAL PRESENTATION
Raised ICP is an expected complication of bacterial
meningitis and the major cause of obtundation (A
dulled or reduced level of alertness or
consciousness ) and coma.
Specific clinical features may provide clues to the
diagnosis of individual organisms
The most important of these clues is the rash of
meningococcemia, which begins as a diffuse
erythematous maculopapular rash and rapidly
become petechiae (found on the trunk and lower
extremities, mucous membranes and conjunctiva,
and occasionally on the palms and soles)
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12. ACUTE BACTERIAL MENINGITIS
DIAGNOSIS
Lumbar puncture (LP) is the gold standard
diagnostic tool.
This should be carried out immediately to prevent
delay in treatment.
If there are signs of raised intracranial pressure, a
computed tomography (CT) scan should be carried
out first so that the risk of coning can be assessed .
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13. CEREBROSPINAL FLUID (CSF) ABNORMALITIES
IN BACTERIAL MENINGITIS
Appearance is purulent
White blood cells 10/µL to 10,000/μL; neutrophils
predominate
Red blood cells Absent in nontraumatic tap
Glucose < 2.2 mmol/L (40 mg/dL)
CSF/serum glucose < 0.4
Protein > 0.45 g/L (45 mg/dL)
Gram’s stain Positive in > 60%
Culture Positive in > 80%
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Indication of CT brain scan before LP:
Papilledema
Seizures (focal or generalized)
Known case of brain tumor or systemic cancer
Immune deficiency
Focal neurological signs
Impaired consciousness
15. ACUTE BACTERIAL MENINGITIS
TREATMENT
The goal is to begin antibiotic therapy within
60min of a patient's arrival in the emergency
room (before the results of CSF Gram's stain and
culture)
There is an untreated mortality rate of around
80%, so action must be swift.
If bacterial meningitis is suspected, the patient
should be given parenteral benzylpenicillin
immediately (intravenous is preferable) and
prompt hospital admission should be arranged.
The only contraindication is a history of penicillin
anaphylaxis 15
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16. 1) Adults aged 18–50 yrs with or without a typical
meningococcal rash
• Cefotaxime 2 g IV 4 times daily or
• Ceftriaxone 2 g IV twice daily
2) Patients in whom penicillin-resistant pneumococcal
infection is suspected, or in areas with a significant
incidence of penicillin resistance in the community As for (1)
but add:
Vancomycin 1 g IV twice daily or
Rifampicin 600 mg IV twice daily
3) Adults aged > 50 yrs and those in whom Listeria
monocytogenes infection is suspected (brainstem signs,
immunosuppression, diabetic, alcoholic) As for (1) but add:
Ampicillin 2 g IV 6 times daily or
Co-trimoxazole 50 mg/kg IV daily in two divided doses
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ACUTE BACTERIAL MENINGITIS
TREATMENT
17. 4) Patients with a clear history of anaphylaxis to β-
lactams
Chloramphenicol 25 mg/kg IV 4 times daily plus
Vancomycin 1 g IV twice daily
5) Adjunctive treatment
Dexamethasone 0.15 mg/kg 4 times daily for 2–4
days
Corticosteroids significantly reduce hearing loss
and neurological sequelae, but do not reduce
overall mortality
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ACUTE BACTERIAL MENINGITIS
TREATMENT
19. PREVENTION OF MENINGOCOCCAL INFECTION
Close contacts of patients with meningococcal
infection should be given 2 days of oral
rifampicin.
In adults, a single dose of ciprofloxacin is an
alternative.
If not treated with ceftriaxone, the index case
should be given similar treatment to clear
infection from the nasopharynx before hospital
discharge.
Vaccines are available for most meningococcal
subgroups but not group B, which is among the
most common serogroup isolated in many
countries. 19
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20. ACUTE BACTERIAL MENINGITIS
PROGNOSIS
Mortality rate is 3-7% for meningitis caused by
H. influenza, N. meningitides, or group B
streptococci; 15% for that due to
L.monocytogenes; and 20% for S. pneumoniae.
Risk factors of death:
decreased level of consciousness
seizures within 24h
signs of increased ICP
young age (infancy)
age >60
co-morbid conditions
delayed treatment. 20
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21. ACUTE VIRAL MENINGITIS
Viruses are the most common cause of meningitis,
usually resulting in a benign and self-limiting illness
requiring no specific therapy.
It is much less serious than bacterial meningitis unless
there is associated encephalitis
Immunocompetent adult patients with viral meningitis
usually present with headache (often frontal or retro
orbital), fever, and signs of meningeal irritation coupled
with an inflammatory CSF profile; frequently associated
with photophobia and pain on moving the eyes.
Constitutional symptoms can include malaise, myalgia ,
anorexia, nausea and vomiting, abdominal pain, and/or
diarrhea. 21
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22. ACUTE VIRAL MENINGITIS
Profound alterations in consciousness such as
stupor, coma, or marked confusion, do NOT occur
in viral meningitis and suggest the presence of
encephalitis or other alternative diagnoses.
Seizures or focal neurologic signs or symptoms or
neuroimaging abnormalities indicative of brain
parenchymal involvement are NOT typical of
viral meningitis
A number of viruses can cause meningitis , the
most common being enteroviruses
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23. ACUTE VIRAL MENINGITIS
ETIOLOGY AND EPIDEMIOLOGY
Etiology
CSF cultures are positive in 30-70% of patients
Two-thirds of culture-negative cases of "aseptic"
meningitis have a specific viral etiology identified by
CSF PCR testing
Epidemiology
estimated that the incidence is ~60,000-75,000 cases
per year.
substantial increase in cases during the non winter
months, reflecting the seasonal predominance of
enterovirus and arthropod-borne virus (arbovirus)
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24. ACUTE VIRAL MENINGITIS
LABORATORY DIAGNOSIS –CSF EXAMINATION
Typical profile:
Pleocytosis
Normal or slightly elevated protein concentration
(0.20.8 g/L [20-80 mg/dL] )
Normal glucose concentration
Organisms are NOT seen on Gram's stain of CSF.
Rarely, PMNs may predominate in the first 48h
of illness, especially with infections due to
echovirus 9, West Nile virus, eastern equine
encephalitis (EEE) virus, or mumps.
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25. ACUTE VIRAL MENINGITIS
LABORATORY DIAGNOSIS –PCR
Amplification of viral-specific DNA or RNA from
CSF using PCR amplification has become the
single most important method for diagnosing
CNS viral infections.
Diagnostic procedure for enteroviral , HSV, CMV,
EBV, VZV, and HHV-6.
PCR of stool specimens may also assist in
diagnosis of enteroviral infections.
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26. ACUTE VIRAL MENINGITIS
TREATMENT
Treatment of almost all cases of viral meningitis
is primarily symptomatic and includes use of
analgesics, antipyretics, and antiemetics.
Oral or IV acyclovir may be of benefit in patients
with meningitis caused by HSV-1 or -2 and in
cases of severe EBV or VZV infection.
Data concerning treatment of HSV, EBV, and
VZV meningitis are extremely limited.
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27. ACUTE VIRAL MENINGITIS
PROGNOSIS
In adults, the prognosis for full recovery from
viral meningitis is excellent.
Rare patients complain of persisting headache,
mild mental impairment, incoordination, or
generalized weakness for weeks to months.
The outcome in infants and neonates (< 1 year) is
less certain; intellectual impairment, learning
disabilities, hearing loss, and other lasting
sequelae have been reported in some studies.
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28. TUBERCULOUS MENINGITIS
Tuberculous meningitis is now uncommon in developed
countries except in immunocompromised individuals,
although it is still seen in those born in endemic areas
and in developing countries.
It is seen more frequently as a secondary infection in
patients with the acquired immunodeficiency syndrome
(AIDS).
Clinical features of tuberculous meningitis :
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29. TUBERCULOUS MENINGITIS
Onset is much slower than in other bacterial meningitis
over 2–8 weeks.
If untreated, it is fatal in a few weeks but complete
recovery is usual if treatment is started early.
When treatment is initiated later, the rate of death or
serious neurological deficit may be as high as 30%.
The tubercle bacillus may be detected in a smear of the
centrifuged deposit from the CSF but a negative result
does not exclude the diagnosis.
The CSF should be cultured but, as this result will not
be known for up to 6 weeks, treatment must be started
without waiting for confirmation.
Brain imaging may show hydrocephalus, brisk
meningeal enhancement on enhanced CT or MRI, and/or
an intracranial tuberculoma.
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30. TUBERCULOUS MENINGITIS
Management
As soon as the diagnosis is made or strongly
suspected, chemotherapy should be started using
one of the regimens that include pyrazinamide.
The use of corticosteroids in addition to anti-
tuberculous therapy has been controversial,
recent evidence suggests that it improves
mortality, especially if given early, but not focal
neurological damage.
Surgical ventricular drainage may be needed if
obstructive hydrocephalus develops
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31. VIRAL ENCEPHALITIS
Definition
Viral meningitis with the infectious process and
associated inflammatory response are limited
largely to the meninges
Viral encephalitis involved the brain parenchyma
Many patients with encephalitis also have
evidence of associated meningitis
(meningoencephalitis) cases, involvement of the
spinal cord or nerve roots (encephalomyelitis,
encephalomyeloradiculitis)
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33. VIRAL ENCEPHALITIS
CLINICAL MANIFESTATIONS
In addition to the acute febrile illness with evidence of
meningeal involvement characteristic of meningitis, the
patient with encephalitis commonly has an altered level
of consciousness(confusion, behavioral abnormalities, or
coma)
Patients with encephalitis may have hallucinations,
agitation, personality change, behavioral disorders, and,
at times, a frankly psychotic state.
Focal or generalized seizures occur in many patients with
encephalitis.
The most commonly encountered focal findings are
aphasia, ataxia, upper or lower motor neuron patterns of
weakness, involuntary movements (e.g.myoclonic jerks,
tremor), and cranial nerve deficits (e.g.ocular palsies,
facial weakness)
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34. VIRAL ENCEPHALITIS
Etiology
In the United States, there are an estimated
~20,000 cases of encephalitis per year
Hundreds of viruses are capable of causing
encephalitis, only limited are identified → most
commonly in immunocompetent adults are
herpes viruses(HSV, VZV,EBV)
The distribution of lesions varies with the type of
virus.
For example, in herpes simplex encephalitis, the
temporal lobes are usually primarily affected,
whereas cytomegalovirus can involve the areas
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35. VIRAL ENCEPHALITIS
INVESTIGATIONS
CSF Examination
The characteristic CSF profile is indistinguishable from
that of viral meningitis and typically consists of a
lymphocytic pleocytosis, a mildly elevated protein
concentration, and a normal glucose concentration
CSF PCR
CSF PCR has become the primary diagnostic test for
CNS infections caused by CMV, EBV, HHV-6, and
enteroviruses
CSF culture
CSF culture is generally of limited utility in the
diagnosis of acute viral encephalitis
Imaging
Imaging by CT scan may show low-density lesions in the
temporal lobes but MRI is more sensitive in detecting
early abnormalities.
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36. VIRAL ENCEPHALITIS
TREATMENT
Basic management and supportive therapy should
include careful monitoring of ICP , fluid restriction,
avoidance of hypotonic intravenous solutions, and
suppression of fever.
Antiepileptic treatment may be required and raised
intracranial pressure may indicate the need for
dexamethasone.
Optimum treatment for herpes simplex encephalitis
(aciclovir 10 mg/kg IV 3 times daily for 2–3 weeks)
has reduced mortality from 70% to around 10%
This should be given early to all patients suspected of
having viral encephalitis
Some survivors will have residual epilepsy or
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37. BRAINSTEM ENCEPHALITIS
This presents with ataxia, dysarthria, diplopia or
other cranial nerve palsies.
The CSF is lymphocytic, with a normal glucose.
The causative agent is presumed to be viral.
However, Listeria monocytogenes may cause a
similar syndrome with meningitis (and often a
polymorphonuclear CSF pleocytosis) and requires
specific treatment with ampicillin (500 mg 4
times daily
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38. BRAIN ABSCESS
Definition
A brain abscess is a focal, suppurative infection
within the brain parenchyma, typically
surrounded by a vascularized capsule.
The term cerebritis is often employed to describe
a non-encapsulated brain abscess
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Abo
Ali
39. BRAIN ABSCESS
Epidemiology
A bacterial brain abscess is a relatively
uncommon intracranial infection, with an
incidence of ~ 0.3-1.3:100,000 persons per year.
Predisposing conditions include otitis media and
mastoiditis, paranasal sinusitis, pyogenic
infections in the chest or other body sites,
penetrating head trauma or neurosurgical
procedures, and dental infections
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Neurology
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Dr.
Rami
Abo
Ali
40. BRAIN ABSCESS
Etiology
A brain abscess may develop:
By direct spread from a contiguous cranial site of
infection, such as paranasal sinusitis, otitis media,
mastoiditis, or dental infection
Following head trauma or a neurosurgical procedure
As a result of hematogenous spread from a remote
site of infection.
Haematogenous spread may lead to multiple
abscesses.
Untreated congenital heart disease is a
recognised risk factor 40
Neurology
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Dr.
Rami
Abo
Ali
41. BRAIN ABSCESS
Clinical Presentation
Typically presents as an expanding intracranial
mass lesion
The classic clinical triad of headache (>75%),
fever (50%), and a focal neurologic deficit (60%).
Seizure presents in 15-35% of patients.
Hemiparesis is the most common localizing sign
of a frontal lobe abscess.
Signs of raised ICP: papilledema, nausea and
vomiting , and drowsiness or confusion → can be
the dominant presentation of some abscesses 41
Neurology
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Dr.
Rami
Abo
Ali
42. BRAIN ABSCESS
Diagnosis
Diagnosis is made by neuroimaging studies.
MRI is better than CT for demonstrating
abscesses in the early (cerebritis) stages and is
superior to CT for identifying abscesses in the
posterior fossa.
Microbiologic diagnosis of the etiologic agent is
most accurately determined by Gram's stain and
culture by CT-guided aspiration.
42
Neurology
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Dr.
Rami
Abo
Ali
44. BRAIN ABSCESS
Diagnosis
LP should not be performed in patients with
known or suspected focal intracranial infections
such as abscess or empyema because it increases
the risk of herniation
CSF analysis contributes nothing to diagnosis or
therapy
There may be an elevated white blood cell count
and ESR in patients with active local infection.
The possibility of cerebral toxoplasmosis or
tuberculous disease secondary to HIV infection
should always be considered
44
Neurology
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Dr.
Rami
Abo
Ali
45. BRAIN ABSCESS
Treatment
Optimal therapy of brain abscesses involves a
combination of high-dose parenteral antibiotics
and neurosurgical drainage.
Typically includes a 3rd or 4th generation
cephalosporin and metronidazole.
Vancomycin for coverage of staphylococci
Aspiration and drainage of the abscess are
beneficial for both diagnosis and therapy
45
Neurology
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Dr.
Rami
Abo
Ali
46. BRAIN ABSCESS
Treatment
Complete excision of a bacterial abscess via
craniotomy or craniectomy is generally reserved
for multi-loculated abscesses or those in which
stereotactic aspiration is unsuccessful
Medical therapy alone should reserved for
neurosurgically inaccessible, small, or non-
encapsulated abscesses
All patients should receive a minimal of 6-8
weeks of parenteral antibiotics therapy
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Neurology
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Dr.
Rami
Abo
Ali