Meningitis

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Meningitis Powered By Docstoc
					PROBLEM SOLVING
A

25 year old lady attended the medicine OPD with complains of fever, headache and vomiting of 3 days duration. She gives history of ear infection, two weeks back. On examination she was febrile; pulse rate -54 per min; BP -150/90mmHg; neck stiffness +; no other neurological deficit. Other system examination WNL.

QUESTIONS
your diagnosis?  What are the investigations you order in this patient?  Outline the management?
 What is

Positive points in the history
 Fever

 Headache  Vomiting  Bradycardia
 Hypertension

 Neck

stiffness

Symptoms of raised intracranial tension
 Headache

 Vomiting

of vision  Seizures  Altered mental status
 Fundus

 Blurring

examination - Papilloedema

Normal fundus

Papilloedema

Papilloedema

Signs of meningeal irritation
 Neck

rigidity sign sign - Leg sign, Neck sign

 Kernig’s

 Brudzinski’s

Kernig’s sign

Brudzinski’s sign

Diagnosis
meningitis  Bacterial  Underlying otitis media
 Acute

Etiologic agents
   

Streptococcus pneumoniae Neisseria meningitidis

Group.B streptococcus Listeria monocytogenes Hemophilus influenza



Age distribution
 <2yrs

– Escherichia coli

2

– 20 yrs – Neisseria meningitidis - Strep pneumonia invasive procedures - Staph

 >20yrs

 Following

Investigation
 Lumbar

puncture

 CT

scan

 MRI

Treatment
 Antibiotics–

3rd genern Cephalosporins

(Ceftriaxone) Penicillin G - N.meningitidi Mannitol Dexamethasone

Complications
impairment  Decreased intellectual function  Seizures  Hearing loss  Dizziness  Gait disturbances
 Memory

Viral meningitis
( Coxsackie, Echo, Polio)  Herpes simplex virus (HSV -2)  HIV (5, 7 & 8 cranial nerve involovement)  Lumbar puncture
 Treatment Enteroviruses

Acyclovir

Fungal meningitis
neoformans  Indian ink staining  Rx – AmphotericinB - iv
 Cryptococcus

Cryptoccocal meningitis: CSF

Indian ink examination

Tuberculous meningitis
spread  Evolves over 1-2 wks  Paresis of cranial nerves (Ocular nerve)  Hydrocephalus  LP – corner stone of diagnosis  Tuberculoma  Rx – Anti TB drugs + Corticosteroids
 Hematogenous

CSF Finding
Normal Bacteri TB
Opening Pr 50 -180 (mm of water) Cells Glucose <5/ microL 40 – 70 mg/dl >180 >200

Viral
100

Fungal
100

Polymorph <40

L <40

L Normal / Low

L Normal/ Low

Protein
Staining

20-50mg/dl

>50
Gram

>100
AFB Indian ink


				
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posted:11/16/2008
language:English
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