Infectious Neurologic

Disorders
 Introduction

 The infectious disorders of the nervous system include

meningitis, brain abscesses, various types of encephalitis,
and CreutzfeldtJakob disease

 The clinical manifestations, assessment, and diagnostic

findings as well as the medical and nursing management
are related to the specific infectious process
Meningitis
 Inflammation of the lining around the
brain(Meninges) and spinal cord caused by
bacteria or viruses.
 Meningitis is classified as septic(Bacteral) or
aseptic(Viral).
 The septic form is caused by bacteria such as
Streptococcus pneumoniae and Neisseria
meningitidis
The meninges
Pathophysiology
 The causative organism enters the bloodstream, crosses
the blood–brain barrier, and triggers an inflammatory
reaction in the meninges.
 Originate from two ways:
Bloodstream from other infections (e.g cellulitis)
Direct extension (after a traumatic injury to the facial
bones).
 Bacterial or meningococcal meningitis also occurs as an
opportunistic infection in patients with acquired
immunodeficiency syndrome (AIDS)
Pathophysiology
 Bacterial meningitis is the most common form.
 The common bacterial pathogens are N.
meningitidis (meningococcal meningitis) and S.
pneumoniae, accounting for 80% of cases of
meningitis in adults.
Clinical Manifestations
 Headache
 Fever
 Nuchal Rigidity
 Disorientation and memory loss
 Seizures
 Increased ICP
 Positive Kernig’s sign; meningitis or SAH
 Positive Brudzinki’s sign; more sensitive test
Diagnostic

 Gram staining of CSF and blood.

 Bacterial Culture
 Medical Management
 Vancomycin hydrochloride in combination with one of the
cephalosporins (eg, ceftriaxone sodium, cefotaxime sodium) is
administered by intravenous (IV) injection.
 Dexamethasone (Decadron) has been shown to be beneficial as adjunct
therapy in the treatment of acute bacterial meningitis and in
pneumococcal meningitis.
 Dehydration and shock
 Seizures- Phenytoin (Dilantin).
 Increased ICP is treated as necessary
 No specific treatment for viral meningitis
 Antibiotics do not work on viruses
 Pay careful attention to personal hygiene
Nursing Management
Prognosis depends largely on the supportive care provided.
Related nursing interventions include the following:
 Assess neurologic status and vital signs constantly.
 Determine oxygenation from arterial blood gas values and
pulse oximetry.
 Mechanical ventilation as prescribed.
 Assess blood pressure which may precede cardiac or
respiratory failure.
 Nursing Management
 Rapid IV fluid replacement may be prescribed, but take care not to
overhydrate patient because of risk of cerebral oedema.
 Reduce high fever to decrease load on heart and brain from
oxygen demands.
 Protect the patient from injury secondary to seizure activity or
altered level of consciousness (LOC).
 Daily wt monitoring; serum electrolytes, urine volume, specific
gravity, and osmolality
 Nursing Management
 Prevent complications associated with immobility, such as
pressure ulcers and pneumonia.
 Institute infection control precautions until 24 hours after
initiation of antibiotic therapy (oral and nasal discharge is
considered infectious).
 Inform family about patient’s condition and permit family to
see patient at appropriate intervals.
Complications

 Advanced bacterial meningitis can lead to brain

damage, coma, and death
 Survivors can suffer long-term hearing loss,
mental retardation, paralysis, and seizures
 Encephalitis

 Inflammation of the parenchyma of the brain and

spinal cord.
 Mostly caused by a virus. Others; fungi
 Arbovirus encephalitis (transmitted by ticks and
mosquitoes)
 Herpes simplex virus encephalitis may occur as a
complication of measles, chickenpox, or mumps.
Clinical Manifestations
• Fever  Since these are viral in
• Headache nature, management is
• Seizures symptomatic.
• Nuchal rigidity  Herpes simplex can be
• Altered LOC
treated with a 10 day
• Agitation course of acyclovir, an
• Restlessness or lethargy antiviral agent.
• Drowsiness
• Photophobia
• N/V
Diagnosis

 Neuroimaging, such as a brain MRI or CT scan.

 A lumbar puncture (spinal tap) to check for signs of
infection in the brain or spinal cord.
 Electroencephalogram (EEG) to look for seizures or
specific patterns of electrical activity in the brain
End…

 Questions