yes

Episode 45: Neurology Clerkship Shelf Review Part 2

• CSF findings of meningitis

Congenital and Acquired Mechanisms Implicated in the Etiology of Central Precocious Puberty | Endocrine Reviews | Oxford Academic

Untitled

HSV meningitis or HSV encephalitis

• CSF findings?
  • Elevated WBCs (lymphocytic predominance)
  • Lots of RBCs (but < 1000)
    • Note: If 4000-5000 RBCs → think SAH instead
  • Elevated protein
  • Normal glucose
• Location? Temporal lobe
• Dx? HSV PCR of CSF
• Tx? IV acyclovir
• Young adult patient + fever + headache + neurologic deficits + no nuchal rigidity→ brain abscess
• Headache + high fever + sudden-onset nuchal rigidity + → bacterial meningitis
  • CSF findings?
    • Elevated WBCs (neutrophilic predominance)
      • Note: in contrast, Tb meningitis is the only bacterial meningitis with lymphocytic pleocytosis
    • HIGH protein
    • LOW glucose

#1 cause bacterial meningitis in children through middle-aged adults? Strep pneumo

• Tx for bacterial meningitis? Ceftriaxone + vancomycin + steroids
• #1 cause bacterial meningitis in neonates? Group B Strep (Strep agalactiae)
  • Tx for neonatal meningitis? Cefotaxime + vancomycin + ampicillin
    • Cefotaxime covers GBS
    • Vancomycin covers Staph aureus & resistant Strep pneumo
    • Ampicillin covers Listeria
• Special bacterial cause of meningitis seen in neonates & elderly only? Listeria monocytogenes
  • Tx? Add ampicillin to standard bacterial meningitis tx
• What pathogen causes bacterial meningitis in young adult sxs of skin petechiae? Neisseria meningitidis
  • Tx? Ceftriaxone
  • PPX for close contacts? Rifampin, ciprofloxacin, or ceftriaxone (“RCC”)
  • Prevention? Neisseria meningitidis vaccine

Pt with Neisseria meningitidis meningitis becomes profoundly hypotensive + hypoglycemic + hyperkalemic + bleeding from mucosal sites. Dx? → Waterhouse-Friedrichson syndrome