pneumoniae r Be TOup B stre monocytogene photophobia ‘Sea and von: Sia miting ns: Nuchal rigidity 1s of your hands at the occiput Support the patient's head with the fi es the chest. Flex the patient’s head gently until the chin touch Positive Brudzinski's sign: exion of knees, in re: lex (involuntary) fle sponse to neck, It is refl flexion The patient al position’ assumes a “fetThe patient lies supine. ‘ Flex one of the patieRt Seg atthe hip é& the knee, with yo hand to extend the KNEE only “elt hy Positive Kernig’s sign: Pain (due to re the hamstrings) The other leg may flex at the KNEE & the Hip Other Possible Signs: Focal neurologic findings ~ hemiparesis, visual field nerve palsies Use your rig defects, Fundoscopic findings = papilledema, absent venous Pulsationd Rash ~ maculopapu = Purpuric rash 1, petechial, or purpuric ( % of meningococcal meningitis) Blood cultures before starting antibiotics. CT scan: CT scan of head is necessary BEFORE lumber puncture if there possibility that a space occupying lesion may cause hemiation ( coning). CT scan of head however should NOT delay antibiotic reatmen presumptive meningitis. Indications of CT scan BEFORE lumber. Puncture are: pilledema en and adults. k antibiotics for 2-4 dayDeafness (CN Vin p; alsy) Cerebral edema Most common Communicating & non-comm Ventriculitis (infl the Hyponatremia icating hydroce lammation of the w : rentricles seen in f ubdural empyema Indication for Prophylaxis: Household contacts - during the 7 days prior to disease or: Child-care & nursery school contacts Aircraft contacts for persons seated next to the tient fo Contact with patient's oral secretions during 7 days p disease onset Kissir Sharing of toothbrushes ating utensils sscitation Sharing of & Mouth-to-Mouth resu Endotracheal intubation oral rifampicin for two days — 12 months 5 mg/kg 12-hourly a hourly 10 mg/kg n, OR ifampicit of 500 mg Gi cin zs pprofloxa le doseMeningococcal Vaccines They are for prevention of disease caused fy groups A and ¢ Y Meningeal Tey are not useful for group B, which i the mogy neneh ‘ommen seragy Itis caused by Mycobacterium tuberculosis, It results from complication ¢ of primary tuberculosis, Most common site: base of the brain Symptom Headache and low-grade fever, Vomiting Lassitude, depression, Confusion and behavioral changes Signs of meningism (headache, photophobia, and neck rigigi absent 'Bidity) may Oculomotor palsies Papilledema Focal neurologic signs Treatment: Anti-tuberculous therapy (ATT) + steroids Steroid decreases mortality, but not focal neurologic damage Meningiti Pressure (9-18.em | Increased =| Normal Increased H20) [Cloudy —SC=*S «lear Cloudy 10 - 2000 50 - 5000 cells/mm? cells/mm? Mononuclear Mixed; initially (lymphocytes) | polymorphs, then mononuclear NormalAcute pee cal neurologi Altered level of consciousnes: ¢ Meningism occurs IN many patient Best initial t al test a scan (because of presence of Lumber Puncture Cells lymphocytes Protein raised Glucose normal RBCs present PCR of CSF is the most accurate for HSV — encephalitis, and CMV and Enteroviruses. MRI = characteristic tem EEG = to rule out se izure, findings in en poral lobe abnormalities in HSV encep ephalitis are — convulsant therapy ethasone (8mg, 12+ VZV = intravenou or without foscar hourly) for raise d intracranial 1s acyclovir net nciclovir with care for other etiologiesraw Misoov MEDICINE = Itrefe = It most commonly affects the frontal lobe, follow Ontars0ve, followed by parietal = Agents: ae Streptococci ~ overall most common agent Staphylococcus~ most common agent in a Penetrating injuri Anaerobes ere Polymicrobial (multiple organisms in 80 - 90% cases) to focal suppurative infection of the brain Parenchyma, . ve of Infection: Penetrating injury Mastoiditis; Sinusitis Acute bacterial endocarditis Bronchiectasis Cyanotic congenital heart disease. Features: Headache, most common feature. It is dull and constant, Focal neurologic deficits and seizures Signs of raised intracranial pressure. CN Il and CN VI palsy. CT scan = ring-enhancing lesion with a low-density core. Tt is the best initial test. (lumber puncture should never be first) ; Ting-enhancing lesion with a low-density core. fure is not necessary and may precipitate brainstem_Neurosyphilis: It is the tertiary sta, It presents with following a following majc It is characterized by pathol Presentation: —° Stroke syndrome - in a relat Meningitis invol 1 base of br Cranial nerve palsies " Hydrocephalus Leptomeningeal granulomas ~ General Paralysis of Insane ( Tt is chronic, progressive resultant loss of cortical function. Characterized by (PARESIS): Personality changes Affect - apathy, w ithdrawal, then euphoria, | Reflexes bilateral UMN signs (hyPer reflexi Eye - Argyll-Robertson pupil SGensoriuim - hallucinations delusions, illusions Ir _ impaired recent me fronto-temporal meningoencephalitis with smory, judgement, insight 0 years):Opriocept ve ataxia gait i Argyll-Robertson pupil lappin, pilateral small pupils that constrict whhgh mmodate) but do not constrict Wh I hat accommodate, but don't react agai sociation’ CSF Examination: Elevated WBC count > 20 cells/jul OR: Positive CSF VDRL — OR: Positive CSF intra-thecal T, pallidum antibody index Injection of procaine benzyl penicillin and probenecid for 17 day ys. Further courses of penicillin are given if condition is not improved, Poliovirus: o Subgroup of enterovirus 0 Transmission = through nasopharynx | © Incubation period = 7 - 14 days * Causes encephalitis and myelitis. = Destroys anterior hom cell motor neurons (lumber flaccid paralysis occurs from respiratory failure. on = live (Sabin) vaccinePath rex ine ~ OR Doster Post posure pre Hypetimmun The d Tanunoglob Half ht H. oR different site fn Days~0, 3,7, 14,30 and 90, Presents with cc CSF itive decline, spasticity of lim Treatment = none (anti-viral therapy is ineffective halitis caused by JC polyomavirus. igodiendrocytes therefore dem rlination is the principa ression count is <50 cell/mm3) ) — diffuse high signa lerlying <