leftgetmy.blogg.se - Cryptococcal meningitis csf findings

Purulent infection: Cerebritis, brain abscess, or subdural empyema.

CVT (cerebral venous thrombosis), including cortical vein thrombosis.

Evaluate for the possibility of underlying endocarditis.

Acute ischemic stroke may occur in ~25% of patients.

Neurologic complications of bacterial meningitis include Neurological sequelae of bacterial meningitis

In general, a lower index of suspicion is appropriate for patients who have been admitted to the hospital for a few days, unless they have a disease process that could cause meningitis (e.g., bacterial endocarditis, pneumococcal bacteremia, status post neurosurgery).

It is uncommon for a patient admitted with an unrelated problem to suddenly develop meningitis while in the hospital.

Fever and altered mental status are extremely common among patients admitted to the hospital.

#3/3: patients admitted to the hospital for awhile

Abnormal findings on EEG that are consistent with encephalitis.

Seizure activity not related to a pre-existing seizure disorder.

New neuroimaging findings suggestive of encephalitis.

Documented fever >38C within the last 72 hours before or after presentation.

(1) Altered mental status lasting >24 hours, without an alternative cause identified.

The following criteria shouldn't mandate clinical management of an individual patient, but they may help us conceptualize the approach to a patient who might have encephalitis.

For example, patients are often obtunded and thus unable to participate in a detailed neurologic examination.

Among critically ill patients, meningitis and encephalitis can be indistinguishable.These features may not immediately lead to a suspicion for infection. Encephalitis tends to present with more prominent focal neurologic findings and/or seizures.Patients with encephalitis usually lack nuchal rigidity.#2/3: suspicion for encephalitis encephalitis is tricker to diagnose than meningitis When in doubt, it's generally better to err on the side of getting a lumbar puncture (especially among intubated patients who can't be closely observed for deterioration).95% of patients with bacterial meningitis will have at least two of the following four cardinal symptoms: fever, nuchal rigidity, altered mental status, and headache.However, only one feature is quite nonspecific. Nearly all patients with meningitis (~99%) will have at least one of these three features.( 27062097) If encountered this combination is highly suggestive, but it has a low sensitivity. All three features are only seen in about 40% of patients.The classic triad of meningitis is fever, nuchal rigidity, and altered mental status.Often present, but under recognized as a symptom of CNS infection.Stiffness to flexion-extension reflects meningeal irritation, whereas stiffness to rotation does not. Nuchal rigidity is resistance to passive flexion.#1/3: suspicion for meningitis frequency of symptoms in patients with bacterial meningitis ( 27062097) External cooling, if needed to achieve normothermia.Scheduled acetaminophen (1,000 mg PO q6hr for most patients).(Subsequently adjust antibiotics based on LP results.).Therapeutic approach ✅ initial empiric therapy prior to LP 📖 Noninfectious differential diagnoses (e.g., ischemic stroke, PRES).Patterns of parenchymal involvement may suggest various types of infectious or autoimmune encephalitis.Diagnoses that may be clarified by MRI include:.MRI may be considered if the diagnosis remains elusive despite the above tests.Hold DVT prophylaxis to facilitate lumbar puncture.Addition of CT angiography ( CTA) and venography ( CTV) should be considered in patients with focal neurologic abnormality or stupor/coma (e.g., bacterial meningitis may cause arterial or venous occlusion).

CT is indicated prior to LP in patients with substantially altered mental status.Electrolytes, complete blood count with differential, coagulation studies.Rapid reference, approach to obtundation with suspected CNS infection