Meningitis pdf - د. زهير

Medicine

Dr. Zuhair

Neurology

“

Meningitis

”

Dr. Zuhair

LECTURE 16

Meningitis Dr. Zuhair

Meningitis

Objectives



To know about clinical presentation of meningitis and Encephalitis



To know about the common infective organisms responsible meningitis and

encephalitis.



To know about the pathophysiology of meningitis and Encephalitis



To know how to investigate a patient suspected of intracranial infection



To know the main differential diagnosis of meningitis and of encephalitis



To know about empirical treatment of meningitis and encephalitis



To know about complications of meningitis and Encephalitis

Sites



Meningitis



Encephalitis



Parameningeal: sinusitis, mastoiditis, otitis media, brain abscess and spinal

epidural abscess.

Presentation:



Fever



Headache



Vomiting



Neck pain and signs of meningeal irritation.



Disturbed consciousness



Seizures



Focal neurological manifestations



Manifestations of the causative agent.

Meningitis Dr. Zuhair

Pathophysiology



Inflammation -> fibrinous exudate -> fibrosis



Subpial Encephalopathy



Increase intracranial pressure



Brain Oedema -> herniation



Vasculitis -> infarcts



Venous sinus thrombosis



Hydrocephalus



Encephalitis -> Direct dysfunction of areas of brain

Atiology:

Infective



Bacterial

 Acute: Pneumo, Meningo, H.Inf, List.mono
 Subacute: TB, Ricketseal and Brucellosis



Viral: H.simplex, V.Z, E.Bar, JC and others



Fungal

Non infective ->



Connective Tissue



Malig: fixed, Leuk, Lymph



Radiation, Chemeical

Meningitis Dr. Zuhair

CSF Analysis:

Other CSF parameters:



Manometry



Gram stain



Sereological



Procalcitonin



PCR

Meningitis Dr. Zuhair

Cases:

1) 10 years old boy presented with fever headache, photophobia and

vomiting of 3 days duration, was very toxic, history of similar condition
in his brother was noted, which lead to death. O/E Neck stiffness and
Kernig’s sign were positive. CSF: protein 120 mg/dl, sugar 39 mg/dl
(blood 99 mg/dl), cells: 600 WBC, 90% Neutrophils. Gram stain shown
below, also picture of his brother’s condition is shown below:

What is the most likely pathogen?

2) 5 years old boy presented with fever headache and vomiting of 3 days

duration, O/E Neck stiffness and Kernig’s sign were positive. CSF:
protein 120 mg/dl, sugar 39 mg/dl (blood 99 mg/dl), cells: 600 WBC,
90% Neutrophils. Gram stain shown below:

What is the most likely pathogen?

Meningitis Dr. Zuhair

3) 35 years old man known thalasemic presented with fever headache and

vomiting of 3 days duration, O/E Neck stiffness and Kernig’s sign were
positive. CSF: protein 200 mg/dl, sugar 39 mg/dl (blood 99 mg/dl), cells:
2600 WBC, 90% Neutrophils. Had a history of splenctomy 1 year ago.
Gram stain shown below:

What is the most likely pathogen?

4) 30 years old pregnant lady with fever headache and vomiting of 5 days

duration, with acute onset deterioration in level of consciousnss following
a complaint of double vision.
O/E Neck stiffness and Kernig’s sign were positive. Bilateral VI, and
spastic quadriparesis. CSF: protein 200 mg/dl, sugar 39 mg/dl (blood 99
mg/dl), cells: 300 WBC, 90% Neutrophils.

What is the most likely pathogen?

Meningitis Dr. Zuhair

5) 17 years old girl brought to A&E with severe agitation and speaking non

sense, sustained three fits each preceded by abnormal sense of smell for
few seconds. O/E there was mild neck stiffness, Kernig sign was
negative. However she was Dilerious. CSF showed protein 67 mg/dl,
sugar normal, cells 10 WBC, all lymphocytes. Gram stain negative.EEG
reveals bilateral temporal spikes and MRI picture shown below.

What is the diagnosis?

Differential Diagnosis:



Meningitis:

  Subarachoid Hemorrhage
  Venous Sinus Thrombosis
  Encephalitis



Encephalitis

  Venous Infarction
  Hemorrhagive Leucoencphalitis
  Meningitis

Meningitis Dr. Zuhair

Investigations



CBC & ESR, U&E, LFT, Nasopharyngeal swab, Blood cultures



CXR



CT scan & MRI brain, also for sinuses, otitis media, and other

parameningeal source.



EEG



MRV & MRI



Tuberculin test



HIV screen

Meningitis Dr. Zuhair

Steroids:



Pyogenic Meningitis: Dexamethason: 4mg q6h iv x 4d



Herpes Simplex encephalitis: Dexamethason 8mg q12h x 4d



TB: 8mg iv q12h x 20 days

Prophylaxis of meningococcal Meningitis:

•  Households, close contact (children)
•  Rifampicine: po q12h x2d
•  <1 year -> 5mg/kg/dose
•  >1 year -> 10mg/kg/dose
•  Adult: 600mg/dose

• Single dose Ciprofloxacin 500mg

Meningitis Dr. Zuhair

Complications:

•  Hydrocephalus
•  Cranial nerves palsies
•  Stroke
•  Dementia
•  Amnesia
•  Aphasias
•  Venous sinus thrombosis
•  Death

END