UNIT 4

• 6-12.
• Shedding of first tooth-final tooth

• Girls: 10
• Boys: 12

• Concrete operations
• Make judgements on what they reason
• Conservation: Changing shape doesn't alter mass
• Classification: Group objects by logical order
• Ability to read & tell time

• Peer group
• Club
• Best friends (same-sex peers)

• Physical or psychological abuse
• Bully: defiant, antisocial
• Victim: characteristics differ from norm, can develop LT depression & low self esteem

• Rules & Rituals: Conformity
• Team Play: Competition
• Quiet Games & Activities: Collections, Board/card/computer games, Reading
• Ego Mastery: Can feel powerful & skillful as their imaginations allow. Need large muscle play

• 1st permanent teeth erupt: 6 yr
• Dental Caries: #1 oral problem in kids/teens
• Maclocclusion problems: Irregular eruption of permanent teeth may impair function. Upper and lower teeth don't approximate
• Dental Injury: require prompt DDS eval

• MVA
• Rear car seat is safest <13 yr

11-20

• Primary: External & internal organs that carry out reproductive functions
• Ovaries, uterus, breasts, penis

• Secondary: Changes throughout the body; result from hormones
• Voice alterations, facial & pubertal hair, fat deposits

Final 20%-25% of height during puberty

Most of the growth during a 24-36 month period growth spurt

• Acceptance by peers
• A few close friends
• Secure love of a supportive family
• Seek mutual affection & equality with parents

Propensity for risk-taking behavior & feeling of indestructibility

• 40% of all teen deaths in US are from MVA
• seatbelts, firearms, sport injuries

IQ 75 or below. Delay in gross, fine motor, speech

Educable mentally retarted: mildly impaired 85%

Trainable mentally retarted: moderately impaired 10%

Extra chromosome 21

↑ risk in women > 35 yoa

• Majority of infants: born to women < 35 yoa
• Translocation: (3-4%): Hereditary; not associated with advanced parental age
• Mosaicism: (1-2%): Cells with both normal & abnormal chromosomes

> 80% survive to age 55 & beyond

Congenital heart malformations

• ↑ respiratory tract infections
• –Hypotonicity of chest & abdominal muscles
• –Impaired immune system

Thyroid dysfunction (hypothyroidism)

↑ incidence of leukemia

Abnormal gene on the lower end of the long arm of the X chromosome

• Adult men
• –Long face with prominent jaw
• –Large, protruding ears
• –Large testes

Children & carrier females: varied manifestations

Behavioral signs: Cognitive impairment, violent temper outbursts, attention deficit, speech delay, hyperactivity

Normal life span

• Most common
• Interference with loudness of sound
• From recurrent serous otitis media

• If permanent: hearing aid to amplify sound
• Absence of well-formed syllables by 11 months of age should result in immediate referral

• Damage to the inner ear structures or auditory nerve.
• Distortion of sound & problems in discrimination
• From congenital defects or acquired conditions: kernicterus, infection, ototoxic drugs, or excessive noise

• Hearing aids do not work as well
• Use cochlear implant: bypasses hair cells to directly stimulate surviving auditory nerve fibers to send signals to the brain; usually by 18 months of age
• Usually has difficulty in articulation

• Interference with transmission of sound in the middle ear & along neural pathways
• From recurrent otitis media

• No defects in conductive or sensorineural structures
• Includes problems expressing the message into meaningful communication

• Myopia
• Hyperopia
• Astigmatism

Light rays fall in front of the retina

Nearsighted (see near objects, but not far)

Corrective lenses or surgery

Light rays fall beyond the retina

Farsightedness (see objects at a distance)

Corrective lenses or surgery

Unequal curves in refractive apparatus

Corrective lenses or surgery

Lazy eye

Reduced visual acuity in one eye

Cross eye

Eye patch or sx

Opacity of the lens

Sx

Increased intraocular pressure

Trauma: foreign objects, penetrating injuries, chemical burns, infections

Most common congenital malignant intraocular tumor of childhood

Mutated gene unable to produce natural signals to stop growth of retinal cells

• Majority: nonhereditary & unilateral
• Cat’s eye reflex: whitish “glow” in the pupil
• Tx: (based on stage of tumor):
• -Surgical radioactive implant, laser photocoagulation, cryotherapy, thermotherapy &/or chemo
• -Enucleation: removal of eye

90% survival

• Complex developmental disorder of brain function with a broad range & severity of intellectual & behavioral deficits
• Manifests between 24-48 months
• 4xs more common in boys
• NOT related to: socioeconomic level, race or parenting style
• Genetic disorder of prenatal & postnatal brain development (2006)
• Immune & environmental factors (e.g., virus) may interact with genetic susceptibility
• Possible autosomal recessive inheritance (60%-96% monozygotic twins)
• No specific gene has been identified
• Does not appear to be caused by MMR vaccine or thimerosal-containing vaccines

• Speech & language delays are common
• Refer: any child who does not babble or gesture by 1 yoa, single words by 16 months, 2-word phrases by 24 months

• Tx:
• Early intervention programs
• Highly structured & intensive behavior modification programs

• Developmentally inappropriate degrees of inattention, impulsiveness & hyperactivity:
• Must be present before 7 yrs
• Symptoms must be present in two settings
• Affect written & adaptive skills, social status & self-esteem

• Learning Disability:
• Significant difficulties in acquisition & use of listening, speaking, reading, writing, reasoning or mathematic skills

Behavioral: focus on preventing undesired behavior. Reward system. Age appropriate consequences.

Environmental: consistency between families and teachers (same goals). Structured. ↓ distractions

• Pharmacologic:
• Psychostimulants:
• –Ritalin & Dexedrine
• –↑ dopamine & norepinephrine levels that stimulate inhibitory system of the CNS
• –Side effects: insomnia, anorexia, ↑ BP

• Tricyclic antidepressants:
• –Imipramine, desipramine & nortriptyline
• –Block norepinephrine & serotonin at the nerve endings & ↑ the action in nerve cells

Clonidine: used with sleep disturbances

• Muscle disuse—tissue breakdown & atrophy
• –↓ strength & endurance

• Joint contracture: altered collagen arrangement
• –Denser tissue—doesn’t glide easily
• –Shortens muscle, tendons & ligaments—↓ joint movement—contracture—↓ function

• Daily stress on bone from weight bearing maintains balance between bone formation & resorption
• –↑ calcium leaves bone—osteopenia—fx?

• •Metabolism:
• –↓ rate, ↑ calcium, ↓ stress hormone production

• •Respiratory:
• –↓ O2 need, ↓ chest expansion, ↓ respiratory muscle strength
• •↑ URI

• •Cardiovascular:
• –Altered distribution of blood volume, dependent edema
• •Orthostatic hypotension, pulmonary emboli, tissue breakdown

• •GI:
• –Distension from poor abdominal muscle tone
• •Constipation, anorexia

• •Urinary:
• –Impaired peristalsis
• •Urinary retention—infection & renal calculi

• •Skin:
• –Tissue injury & ↓ healing

• •Contusions:
• –Damage to soft tissue, subcutaneous structures & muscle
• –Ecchymosis (cold tx: 24-48 hrs)
• •Dislocation:
• –Ligaments hold bones in place
• –Stress on ligament displaces the normal position of the opposing bone ends or bone end to its socket
• •Sprains:
• –Ligament is torn or stretched with damage to other tissues; “feeling loose”
• •Strains:
• –Microscopic tear to musculotendinous unit; pain to touch & swollen; more rapid the strain = more severe

• •Hematoma: “procallus;” 24-48 hr
• •Cellular proliferation: within 2 wks
• –Hematoma changes to granulation tissue & callus forms a soft collar around fx site to connect bone fragments
• •Callus: “bony callus;” 3-4 wks
• •Ossification: mature bone; 3-10 wks
• •Remodeling: resorption of excess; 9 mo.

• Reduction
• Immobilization
• Restore function
• Prevent further injury

• Synthetic: light, quick dry, water resistant, early weight bearing, rough exterior, $, different colors, difficult to write on
• Plaster: molds closely, long dry time, smooth exterior, inexpensive

Neurovascular checks a priority

“Hot” spots after dry may mean infection

• •3 components:
• –Traction (wt to distal bone fragment)
• –Counter traction (body wt)
• –Friction (bed contact)
• •Purposes:
• –↓ muscle spasm
• –Position distal & proximal ends
• –Immobilize
• •All-or-none law:
• –Stretch muscles—spasm stops—can realign bone!

• •Manual: applied by the hand distal to fx
• •Skin: applied directly to skin surface & indirectly to skeletal structures
• •Skeletal: applied directly to skeletal structure with pin, etc.

• •Limb lengthening to occur by manual distraction
• –Separating opposing bone to encourage regeneration of new bone in the space
• •Wires, rings, rods
• •Percutaneous ostomy: create a “false” growth plate
• •Bone growth: 1 cm/mo (max 15 cm)
• •Crutch walking, pin care

• Abnormal hip development
• 16-25% born breech
• 60% female; caucasian
• Risks:
• Physiologic: mom's hormones
• mechanical: breech, multiple fetus, large
• genetic: family hx

• •Dysplasia: mildest; delay in acetabular development
• •Subluxation: majority; partially displaced femur head
• •Dislocation

ASAP

• •Birth to 6 mo:
• –Harness, spica cast
• •6-18 mos:
• –Traction, reduction, spica cast, bracing
• •Older:
• –Operative reduction & casting

• •Pavlik harness
• •Note: DON’T double/triple diaper!
• –Promotes hip extension

•Ankle & foot deformity

•Cause: abnormal embryonic development or in utero positioning

• •Tx:
• –Manipulation
• –Serial casts q 1-2 wks
• –Surgery (failure to achieve normal alignment by 3 mo of age)

Ponseti cast

• •Most common congenital foot deformity
• •Cause: abnormal intrauterine position
• •Pigeon-toed gait
• •Tx: manipulation & stretching or casting

• •Amelia: absence of entire extremity
• •Meromelia: partial absence of an extremity
• –Phocomelia (seal limbs): interposed deficiency of long bones with relatively good development of hands & feet attached at or near shoulder or hips
• •Amniotic band syndrome: full/partial amputation in utero from constriction of an amniotic band
• •Cause: teratogenic effect of meds in 1st trimester of pregnancy (thalidomide, accutane)
• •Tx: prosthetic devices

• •Hereditary (at least 5 types)
• –Autosomal-dominant (most common)
• –Autosomal-recessive (most severe form)
• •Collagen defect (major component in connective tissue)
• •S&S: fx, osteoporosis, skeletal deformities
• •Tx:
• –Meds: promote ↑ bone density
• –Supportive: rods placed for long bones prn
• –Bone marrow transplant?
• •Nursing care: careful handling to prevent fx!

• •Aseptic necrosis of the femoral head
• •3-12 yoa; 4-5x ↑ in boys; ↑ Caucasian
• •Unknown cause
• •Stages:
• –Flattening of upper surface of femoral head
• –Vascular reabsorption of the epiphysis
• –New bone & regeneration of femur head
• •S&S: limp, ache/stiff hip
• •Tx: Traction?, rest, braces, surgery?

• •Spontaneous displacement of proximal femoral epiphysis in a posterior & inferior direction
• •Before or during accelerated growth
• •↑ males & obese
• •Femoral neck slips—deforms femoral head
• •S&S: hip/thigh/knee pain, limp
• •Tx: Presurgery bed rest & traction followed by surgical pinning

• •Bone infection: Direct invasion (exogenous) or spread from a preexisting focus (hematogenous)
• •S&S: fever, local pain/swelling/warmth over involved bone, ↓ ROM
• •Cause: Staph (majority)
• •Dx: cx (blood, joint fluid, pus), ↑ WBC & ESR, biopsy, bone scan, x-ray (after 2-3 wks)
• •Tx: IV antibiotics 4-6 wks, no wt bearing @ 1st

• •Peak: 15-19 yoa; > males
• •S&S: local pain—limp
• •Osteogenic sarcoma: bone ca; 10-25 yoa; most common in long bones (femur)
• –Tx: surgical resection or amputation, chemo
• –85% survival (non metastatic)
• •Ewing Sarcoma: bone marrow ca; 4-25 yoa
• –Tx: radiotherapy & chemo
• –80% 3 yr survival
• •Rhabdomyosarcoma: soft tissue ca; peak < 5 yoa
• –Tx: radiotherapy & chemo
• –65% survival

• •Inflammed synovium with joint effusion & erosion
• –Adhesions between joints & ankylosis
• •Peak: 1-3 yoa; > girls
• •Cause: immune & environmental trigger?
• •S&S:
• –Joints (red, warm, swollen, painful, ↓ ROM)
• –Rash? Fever? Lymphadenopathy?
• –Psoriasis? Nail pits?
• –Vision changes? (uveitis—inflammation in the anterior chamber of the eye)

• •Dx: ↑ WBC & ESR?, antibody tests, radiographs, slit lamp exam
• •Tx:
• –Meds: NSAIDs, methotrexate, corticosteroids, immune modulators
• –Supportive: moist heat, PT/OT (maintain muscle strength & joint mobility)

“group of permanent disorders of the development of movement & posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain” (2006)

• •Most common permanent physical disability of childhood

• •Abnormal muscle tone & coordination
• –Disturbances of sensation, perception, communication, cognition & behavior; seizures

• •Delayed gross motor development
• •Abnormal motor performance:
• –Stand or walk on toes; feeding difficulties
• •Alterations in muscle tone: ↑ or ↓
• •Abnormal postures/reflexes
• –Asymmetric or persistent reflexes
• •Moro reflex beyond 4 mo

• •Early assessment
• –Developmental screen & neuro exam
• •Neuroimaging: MRI preferred
• •Metabolic & genetic testing if no brain structural abnormalities found

Dx often cannot be confirmed until 2 yoa: motor tone abnormalities may indicate another neuromuscular illness!

• •Orthopedic surgery
• –Correct contractures/spastic deformities
• •Control muscle spasms & resulting pain
• –Baclofen (intrathecal pump?) & Valium
• –Botulinum toxin A (Botox): ↓ spasticity in targeted muscles
• •Antiseizure meds

• •Defects from failure of neural tube closure
• •↓ : folic acid & prenatal dx tests
• –Educate childbearing adolescent females about the need for folic acid to prevent neural tube birth defects!

• •Spina bifida occulta:
• –Defect not visible externally; lumbosacral
• •Spina bifida cystica:
• –Visible defect with external saclike protrusion
• •Meningocele: encases meninges & spinal fluid
• •Meningomyelocele: contains meninges, spinal fluid & nerves
• •Encephalocele:
• –Herniation of brain & meninges through defect in the skull producing a fluid-filled sac

• •Failure of neural tube closure
• –During 1st 3-5 gestation wks
• –Multifactorial: drugs, radiation, maternal malnutrition/illness, genetics
• •Degree of neuro dysfunction depends on:
• –Vertebral area where the sac protrudes
• –Anatomic level of the defect
• –Amount of nerve tissue involved
• •80%-90%: hydrocephalus

• •Sac prone to tears
• •Usually: lumbar/lumbosacral
• •If below 2nd lumbar vertebrae:
• –Partial paralysis of lower extremities
• •Defective nerve supply to bladder
• •May develop joint deformities in utero
• •Dimple: may be spina bifida occulta

• •Fetal surgery: new procedure with 4% mortality
• •Meningomyelocele:
• –Early closure within 24-72 hrs after delivery
• •Hydrocephalus management (shunt)
• •Management:
• –Multidisciplinary & multispeciality
• •Orthopedics, GU, GI, Infectious Diseases

• •Neurogenic bladder dysfunction
• –Preserve renal function
• –Achieve optimal urinary continence
• •Tx of renal problems:
• –Treat UTIs
• –Clean intermittent catheterization
• –Meds to improve bladder storage & continence
• –Urinary diversion (Mitrofanoff)
• •Catheterizable channel created from the bladder through a stoma near the umbilicus

• •Prevent trauma to sac
• –Keep moist (normal saline dressings)
• •Positioning:
• –Before surgery: prone & low Trendelenburg (head turned to side & up to feed)
• •General care:
• –Diapering contraindicated until after surgery—needs tactile stimulation
• –Skin care, ROM
• •Observe:
• –Head circumference, ­ temp, signs of ­ ICP
• •Latex allergy (up to 80%)

• •Genetic: gradual degeneration of muscle fibers
• –Progressive weakness & wasting of symmetric groups of skeletal muscles with ­disability & deformity
• •Pseudohypertropic (Duchenne) Muscular Dystrophy:
• –Most common (X-linked; almost only males)
• –Gene mutation that encodes dystrophin (skeletal muscle protein product)

• •Most reach developmental milestones early in life (may have subtle delay)
• •3 - 7 yoa: muscle weakness
• –Difficulties with running, bicycling, climbing stairs
• –Later: abnormal gait (fall, Gower sign, waddle)
• •Pseudohypertrophy:
• –Progressive muscular enlargement from fatty infiltration
• –Result: contractures & deformities
• •Ambulation usually impossible by 12 yoa

• •Dx:
• –Blood PCR for dystrophin gene mutation
• –Prenatal dx (12 wks gestation)
• –Serum creatine kinase ↑, muscle biopsy, EMG
• •Tx:
• –Maintain function as long as possible
• –Corticosteroids?
• –Prevent contractures
• •Prognosis:
• –Death (usually late teens/early 20s):
• •URI or cardiac failure

• •Toxin from anaerobic Clostridium botulinum
• •Most common source: improperly sterilized home-canned foods
• –Also: wound botulism, bioterrorism
• •CNS S&S:12-36 hrs after ingestion
• •Tx: IV antitoxin until paralysis abates
• •Nursing care: supportive

• •Ingest spores/cells of C. Botulinum—release toxins from colonies in GI tract
• •Culprit: honey (appears to be no common food source)
• •Peak: 2-4 months of age
• •S&S:
• –Constipation, generalized weakness & ↓ in spontaneous movement, lethargy, poor feeding
• •Dx: clinical suspicion; detect organism in stool (days)
• •Tx:
• –STAT IV botulism immune globulin (neutralize toxin & stops progression)
• –May need mechanical ventilation, IV feeds
• •Prognosis:
• –Mortality <2% if treated quickly

Craniums volume must remain stable. There is a small window of compensation--further increase in volume results in rapid increase.

Stabalize a child's spine after a head injury until a spinal cord injury is confirmed or ruled out.

Although bleeding from the nose or ears is uncommon in children, it needs further evaluation, & a watery discharge from the nose (rhinorrhea) that is positive for glucose (as tested with Dextrostix) suggests leaking of CSF from a skull fracture

• •Assessment of LOC = earliest indicator of improvement or deterioration of neuro status
• –Alertness
• –Cognition
• •Unconsciousness:
• –Inability to respond to sensory stimuli & have subjective experiences
• •Coma:
• –Cannot arouse even w/painful stimuli

• •Objective LOC measure
• –Eye opening
• –Verbal response
• –Motor response
• •Value 1-5 to each category
• –Normal = 15
• –Coma = 8 or ↓
• –Deep coma = 3
• •Lack of response to painful stimuli = abnormal & should be reported STAT!

• •Temperature:
• –Often↑, sometimes extreme
• •Blood pressure:
• –↑; attempt to bring more blood & O2 to injured tissue with a widening pulse pressure
• •Pulse:
• –↓; pressure on vagus nerve in the lower brain stem
• •Respiratory pattern:
• –Altered; pressure on respiratory center in the medulla
• •In children, actual changes in pulse & BP are more important than the direction of the changes

• Poisoning (opiate or barbiturate)
• Brainstem dysfunction

• After seizures or eye trauma, may be unilateral
• Pressure from herniation of the brain through the tentorium
• Fixed bilaterally > 5 minutes = brain damage

Lesion on the same side

Brainstem damage, hypothermia, poisoning (atropine substances), mydriatic drugs

Observation of asymmetric pupils or one dilated, unreactive pupil in a comatose child is a neurosurgical emergency that may require evacuation of an epidural hematoma!

• Rotate head quickly from one side to the other
• Eyes should move together opposite the movement of the head
• Brainstem or occulomotor nerve damage if eyes move the direction of the head
• Don’t use with C-spine precautions!

• Irrigate external auditory canal with ice water
• Normally causes conjugate movement of the eyes toward the side of the stimulation
• Lost when pontine centers are impaired
• Painful procedure: never do on alert child!

• •Papilledema occurs with ­ ICP
• –Optic disc swelling, hemorrhage, absence of venous pulsations
• •Older children & adults
• •Takes 24-48 hrs
• •Examine for pre-retinal hemorrhages from acute trauma with intracranial bleeding

• •Decorticate:
• –Flexion
• –Severe dysfunction of the cerebral cortex
• •Decerebrate:
• –Extension
• –Midbrain dysfunction

Hypoxia (RR < 4/min): brain damage

Suctioning (or NG tube) through the nares is contraindicated, since there is a high risk of secondary infection & the probability of the catheter entering the brain through the fracture.

• dec. urine volume
• Hyponatremia
• Restrict fluids

• inc. urine volume
• Hypernatremia
• Replace fluids

• •Bruising at point of impact (coup)
• •Bruising where the brain collides away from impact (contrecoup)
• •Sudden deceleration: greatest cerebral injury at the point of impact (e.g. falling)
• •Severe compression of the skull can cause the brain to herniate into the tentorial opening

• •Transient & reversible neuronal dysfunction with instantaneous loss of awareness & responsiveness
• –Traumatically induced alteration in mental status
• –Hallmarks: confusion & amnesia
• •Short time period (min-hr)
• •Cause: shearing forces cause nerve fibers to stretch, compress & tear
• •Observe for neuro changes

• •Bruising/tearing of cerebral tissue
• •Contusion:
• –Petechial hemorrhages along brain at impact (coup) or lesion remote from the direct trauma (countrecoup)
• –May cause focal disturbances in strength, sensation or visual awareness
• •Laceration:
• –Caused by a penetrating wound or depressed skull fracture

• •Pediatric skull ↑ flexible—fewer fx
• •Range of brain damage & arteries can tear
• •Linear:
• –Majority; overlying hematoma/soft-tissue swelling
• •Depressed:
• –Bone breaks, pushes in & tears the dura
• •Open:
• –Opening between skull & scalp or surfaces of the upper respiratory tract; ↑ infection
• •Diastatic:
• –Traumatic separations of cranial sutures (< 3 yoa)

• •Most serious type
• •Break in basal portions of the frontal, ethmoid, sphenoid, temporal or occipital bones
• •Battle sign:
• –Postauricular bleed in mastoid sinus
• •Raccoon eyes:
• –Bleed into frontal sinuses
• •May have CSF leak from nose or ears
• –Antibiotics used prophylactically
• •Associated with cranial nerve injuries

• •Hemorrhage
• •Infection
• –Watch for post traumatic meningitis: fever & ↑ drowsy w/basilar skull fracture
• •Edema
• –From tissue trauma
• •Tentorial herniation

• •Blood accumulates between dura & skull
• •Bleeding usually arterial: rapid brain compression
• •Classic: momentary unconsciousness—normal—lethargy/coma
• –Seldom in peds!
• •May be symptom free for longer than 48 hrs
• •Uncommon <4 yoa

• •Bleeding between dura & cerebrum
• •Cortical vein ruptures—spreads slowly, thinly & widely
• •Common in infants:
• –Birth trauma, falls, violent shaking
• –Peak: 6 months
• •May have high mortality & poor prognosis
• –May have developmental retardation & FTT

• •From structural complications from the head injury
• •Minutes to an hour after the injury
• •Last several days to several months
• •Post traumatic seizures may occur within 2 yrs of injury

• •Infants
• –Pallor
• –Sweating
• –Irritability
• –Sleepiness
• –May vomit
• •Adolescents
• –HA
• –Dizziness
• –Impaired concentration
• •Children
• –Behavioral disturbances
• –Sleep disturbances
• –Phobias
• –Emotional lability
• –Irritability
• –Altered school performance
• –Seizures

2nd accidental cause of death in peds

• •Young children can withstand longer periods of submersion
• •Diving reflex:
• –Neuro response triggered by immersion of face in cold water
• –Blood shunts away from periphery & concentrates to the brain & heart

• •1st priority: restore O2 delivery
• •All should be hospitalized 12-48 hrs for possible respiratory distress & cerebral edema

• –Affects supporting structures of the nervous system
• –Most common brain tumors in children

•S&S depend on anatomic location & size & child’s age

•Most common malignant tumor of infancy

•Younger the child = better prognosis

• •Affects meninges (meningitis) &/or brain (encephalitis)
• •Main pathogens:
• –Bacterial
• –Viral
• –TB

–Purpura or petechial rash—may have meningococcemia—STAT medical attention!

• •LP: cell count, C&S, protein, glucose
• –­ WBC (polys)
• –­ protein
• •Infections ↑ permeability of blood-CSF barrier
• –¯ glucose
• •Compare with serum glucose if possible
• •Blood culture: may grow organism

• Mgmt:
• •Respiratory isolation until on IV antibiotics for 24 hrs
• •Priority: labs, LP, IV antibiotics

• •50% cause—unknown
• –Direct invasion or postinfectious involvement of CNS after viral disease (e.g. herpes)
• •Onset: sudden or gradual
• •Nonspecific signs evolve to focal neuro signs (malaise, fever, HA, stiffness, tremors, seizures—coma & death)
• •Dx: same as meningitis, may have specific serologic test (e.g. West Nile)
• •Tx: mostly supportive, acyclovir for herpes