Jenna Cohen Final Exam Study Guide Cerebral Part 2 CNS Infections They look pretty similar and we treat them all initially like the most serious one bacterial meningitis to begin with not that there will be time distinguishing but that realize the significance or seriousness of each one what are the approaches to take 1st Bacterial Meningitis Acute inflammation of meninges and bacterial CSF infection cerebrospinal fluid Decreased since Hib vaccine begun in 1990 in existence and concern still Various causative agents Strep Pneumonia GBGHS E coli Neisseria meningitides just some of the possibilities Transmission of Bacterial Meningitis precautions if suspect Droplet transmission from nasopharyngeal secretions that s why getting on droplet Appears as extension of infection from other source in body via vascular dissemination or through open outlet to CSF such as lumbar puncture rarely bc we use good technique epidural line open fracture that exposes ur CSF to other agents patients who have shunts placed brain surgery reason why as the infection goes through inflammation and exudate there isn t only edema this tissue brain is covered in pus and this can ecclude the flow get an infection anywhere always a possibility it can move out of the bloodstream and cause infection in other areas Bacterial Meningitis S SX Infant initially subtle especially for an infant fever decreased LOC irritability stiffness septic appearance perfusion may not be top notch just look sick very beginning of shock hard for a patient to pick up on bc you would expect them to cry and be irritable Child N V D general illness signs strange head neck positioning malaise may wake Hyperreactive reflexes whether knees or elbows they will kick up with that quick reflex up and holding neck in a strange way signs specific to meningy irritation Kernig s resist your attempt to extend leg while supine they have their knees up bc they are trying to keep their spinal cord as short and unstretched as possible when you extedn their legs they will resist that attempt bc it will stretch the spinal cord Brudzinski s flex knees when you flex head when you flex their head up they flex their knees inward when they re lying down keeping spinal cord short Purpuric or petechial rash usually a rash bruising bleeding underneath the skin flat patchy reddish area or petechial smaller more pinpoint areas always a clue bacterial meningitis causing these changes Bacterial Meningitis Dx and Tx Dx LP is definitive increased WBC increased protein glucose present CSF may be cloudy lp lumbar puncture getting csf to evaluate if there is a fever of unknown origin if an infant has this for no reason and cannot distinguish a reason for it and look at the other common culprates of UTIs we may do a lumbar puncture particularly if they have signs of BM WBC bc in there to fight infection cloudy from pus and bacteria if concerned about neurostatus they will get CT scan Early and Aggressive Tx to prevent Cxns very important o Broad spectrum IV antibiotics or two to cover this well o Fever Management Assess ABCs decrease the amountof work they have to do to recover are thye going into septic shock o Hydration Droplet Precautions for the first 48 hours lumbar puncture before abx so you get accurate sample get abx right away and droplet will have to be 48 hrs after abx are started o Prophylactic Tx for exposed persons ex clinic or er staff before we started droplet precautions families or other kids in their daycare Cxns Shock long term brain damage Seizures complications brain damage possibility get better at preventing by having early and aggressive tx can have mild delays and deficits to complete neurologic devastation tht leaves them in a vegestative stage seizure bc brain is irritated to it acts out CNS Infections 2nd Viral Aseptic Meningitis Main cause viruses can be some associated with leukemia measles and mumps S SX gradual or rapid onset of h a fever malaise usual not as ill appearing as bacterial usually don t look quite as sick as those with BM diagnosis based on CSF findings there will be no bacteria not cloudy and the WBC will not be as elevated on the fluid however they have the same sx wont know which it is till analysis of lp May have Kernig s Brudzinski s Diagnosis based on CSF Findings Tx Abc and Isolation until certain not bacterial fever control hydration monitor for same Cxns as bacterial 48 hrs generally bc waiting for definitive result on lp which takes 3 4 days Prognosis good better than BM but can and have caused death very concerning situation from viral CNS Infections 3rd Encephalitis Inflammatory process of CNS with altered function of brain and or SC spinal cord Cause variety usually viral are fungus helmiths and protozoa types but usualy comes Vectors in US mosquitoes and ticks carry from sepcies to species and person to person equan types horse and mosquito for transmission S SX may be gradual or sudden mild or severe malaise fever H A dizziness stiff neck N V Ataxia Speech changes LOC gate distrubances ataxia can be much milder Diagnosis LP CT scan often wont pick up on lp that is it protozoa or something Tx abx and isolation until dx certain same as others till dx Acyclovir if viral hydration Monitor for same Cxns as meningitis child can improve can come back and cause greater cxns than it initially did CNS Tumors Brain tumors and neuroblastomas are derived from neural tissue Account for approx 20 of pediatric Cancers Difficult to treat due to location and or spread of the tumor hard to get into brain tissue without affecting the functioning poor survival rates Brain Tumors Most common solid tumor in children o Benign or malignant overall the most common solid tumor in children Evaluation S SX r t size and location but hallmarks are H A worse in am new headache and or seizure clumsy motor or sensory changes projectile vomiting behavior change r t size of tumor and location within brain headache bc of intracranial pressure increase new seizures had and clumsy infant you expect same things but not be meeting developmental milestones either Complete neuro evaluation MRI if don t see tumors there look at ct for something acute that couldn t see CT EEG seizure LP infection histologic dx during surgery based on biopsy of tumor material Treatment of Brain Tumor Depends on type size location Possibilities o Surgery partial or total tumor removal depends how it would affect neurological function typically called a brainiotomy o Chemotx