-
Clinical Presentation of Menigitis
- Fever
- Headache
- Stiff neck
- Nausea
- Vomiting
- Seizures
- Signs of Meningeal irritation- postive kernig's and Budzinski signs
-
Causes of Meningitis in Newborns
(0- 6 Months of age)
-
Causes of Meningitis in Children
(6 months to 6 years)
- HENS
- 1. H. influenzae type B
- 2. Enteroviruses
- 3. N. Meningitidis
- 4. S.pnemoniae
-
Causes of Meningitis in patients 6-60 years of age
- Hens
- 1.HSV
- 2.Enteroviruses
- 3.N.Meningitidis
- 4.S.pneumoniae
-
Causes meningitis in elderly (persons over 60 years of age)
- Grandies Need Some Love
- 1.GNR
- 2. N. Mingingitidis
- 3. S. Pneumoniae
- 4. Listera
-
Tuberculosis Meningitis Etiology
- 1.Caused by Mycobacterium tuberculosis
- 2. Seen in malnourished, debilitated or immunosuppressed people
-
-
Fungal Meningitis Etiology
Common malnourished, immunosuppressed or debitated
- Common Pathogens:
- 1. Cryptococcus
- 2. Candida
- 3. Fusarium
- Rare Pathogens:infections in healthy people
- 1. Histoplasma
- 2. Coccidioides
- 3. Paracoccidiodes
-
Meningitis Diagnostic Studies
- CSF
- 1.Protein and Glucose
- 2.Cell count
- 3.PCR for HSV
Blood Culture
- Latex Agglutination for -H.influ, S.pneumo
- N. Meningitis
CT/MRI- prior to LP if focal signs
-
Contraindictation for LP
- Papilledema
- Focal Neurologic Sign
- Coagulopathy
-
Spinal Fluid Profile for Bacterial Meningitis
- Increased -opening pressure
- Increased WBC 50-10,000 mostly polys
- Increased protein
- Decreased Glucose
-
Spinal Fluid profile in fungal or TB Meningitis
- increased opening pressure
- whites count increased bwt 50-10,000 both polys and lymphs
- Increased protein
- decreased glucose
-
Spinal Fluis Profile in Viral Meningitis
- Normal to slightly increased opening pressure
- WBC 20- 1,000 mostly lymphs
- Slightly Increased protein
- Normal glucose
-
Management of Fungal Meningitis
Hospitalization for observation and IV antifungal medications.
- Medications include
- 1. Amphortericin B
- 2. Flucytosine and be used in addition to increase efficacy
mortality rate 20-50 %
-
Management of Viral Meningitis
mostly supportive care
-
Managment of Bacterial Meningitis
- Hospitalization
- Empirial antibotics
- -Vancomyacin and Ciprofloxacin or
- -Ampicillin
- -Consider giving steroid dexamethasone before antibiotic
- -treat close contacts with rifampin, ciprofloxacin or ceftriaxone
-
Management of TB Meningitis
"RIPE"
- R- rifampin
- I- Isoniazid
- P-pyrazidamide
- E-ethambutal
For 18-24 Months
-
Guillian- Barre Syndrome Definitions
Autoimmune disease that targets gangliosides and leads to rapidly progressing, ascending, areflexic motor paralyses with or without sensory distrubances.
-
Guillain Barre Syndrome Etiology
- Males > than Females
- Adults > Children
- 85% Recovery Rate
- 5% Death Rate
- 60-70% of patients have a acute GI/Respiratory infection proir to neurologic symptoms.
- Organsims assocated with disease include
- 1. Campylobactor Jejuni
- 2. CMV
- 3. EBV
-
Guillian Barre Syndrome inital symptoms
Ascending weakness that evoles over days to reach a peak at 14-30 days
Loss of DTR at about day 3
Bulbar weakness and respiratory muscle paralysis may occur
50% of pat ients havefacial weakness
pains and tingling sensations
-
Treatment of Guillain Barre syndromes
- IV IGG
- Plasma Exchange
- Rehab
- No steroids -not helpful
- monitor FVC FVC< 15 indication for ICU and Intubation
-
Clinical Maniestation of Autonomic Neuropathies
- Orthostatic Hypotension
- Diarrhea
- Constipation
- Early Satiety
- Tachycardia/Palpitation
- Blurred Vision
- Urinary Retention
- Erectile Dysfunction
-
Guillain-Barre syndrome Diagnostic testing
CSF shows increased protein greater than55mg/dl with few or no cells called albulminocytologic
May have positive antibodies
-
-
Managment of Cluster Headaches
May spontaneously regress untill next episode
- inhalation of 100% O2 for 20 mins while
- sitting upright
- Triptans
- Prednisone, veraparmil, methylsergide
trigeminal nerve resecion or injection
-
Management of Mirgrains
Simple Dugs-OTC pain medication taken at 1st onset
Drugs that induce Sleep
Ergotamine, s=- all constrict cerebral and systemic blood vessels and prevents release of inflammatory mediators from trigeminal nerve
N/V may make oral medications ineefective
Triptans
-
Prophylactic Treatment of Migraines
Indicated for patient who have for or more mirgraines a month
- regular excerise
- regular sleep schedule
- avoid alcohol, caffeine or other triggers
Medications- reduce migraines by 50%when taken dailly
- amitriptyline
- olivaloproex sodium
- propanolol
- timolol
-
Management of Tension Type Headaches
- Relaxation techniqques- Hot/Cold paxks
- bths/showers, massage, meditation
OTC analgesics- high doses may cause rebound HAs
Sleep medication
|
|