central nervous system infections
DESCRIPTION
Central Nervous System Infections. Lenka Krbková Klinika dětských infekčních nemocí LF MU, Brno. Questions. Clinical features of CNS infections Aseptic meningitis and encephalitis Septic meningitis Therapy of septic meningitis Cerebrospinal fluid examination - PowerPoint PPT PresentationTRANSCRIPT
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Central Nervous System Infections
Lenka Krbková
Klinika dětských infekčních nemocí
LF MU, Brno
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Questions
• Clinical features of CNS infections
• Aseptic meningitis and encephalitis
• Septic meningitis
• Therapy of septic meningitis
• Cerebrospinal fluid examination
• Differential diagnosis of CNS infections
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Clinical featuresof CNS infections
• 1) General signs of infection
• 2) Meningeal irritation
• 3) Neurological involvement
• 4) Dermatological features
• 5) Signs of raised ICP
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Signs and symptoms of CNS infections
General: fever, chills, malaise, nausea, restlessnesss, photophobia
Meningeal triad: fever, headache, vomiting
Neurological features: neck stiffness, nuchal rigidity, irritability, back pain, stupor, coma, seizures or focal neurological signs
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Neurological signs
• Kernig´s sign
is elicited with the patient in the supine position, in which the thigh is flexed on the abdomen with the knee flexed. The leg is passively extended, and, in the presence of meningeal inflammation, the patient resists leg extension
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Kernig´s sign
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Neurological signs
• Brudzinski´s sign
the best known is the nape-of-the-neck sign, in which passive flexion of the neck results in flexion of the hips and knees
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Brudzinski´s sign
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Amoss´ sign
• In painful flexion of the spine, inability to sit without supporting the arms behind the torso = („tripod position“)
• Patients (children !!!) spontaneously assume the tripod-like position
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Dermatological features
• Maculopapular rash
• Petechial rash
• Purpura
• Dermographism
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Signs in newborns and infants
• Bulging fontanelle
• Opistothonus = powerfull contraction of the back and neck mucsles causing the body to arch backwards so that the heels approximate to the head
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Signs in newborns and neonates• Lethargy
• Refusal to feed
• Weak suck
• Vomiting
• Irritability
• High-pitched crying
• Temperature instability
• Jaundice
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Signs of raised intracranial pressure
• Bulging fontanelle
• Papilloedema
• Bradycardia
• Hypertension
• Altered state of consciousness
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Neurological involvement
• Meningitis
• Encephalitis
• Myelitis
• Acute
• Peracute
• Chronic
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Meningitis x Encephalitis
• Fever• Headache• Vomiting• Meningeal signs• Less frequent:• Somnolence to coma• Focal neurologic signs• Seizures
• Fever• Headache• Depressed mental
status• Focal neurologic signs• Seizures (focal or
generalized)
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Clinical features (encephalitis)• Frontotemporal signs: memory impairment,
aphasia, personality changes (HSV, HHV6, limbic autoimmune encephalitis)
• Rigidity, rest tremor (flaviviral)
• Seizures (involvement of cortex): HSV
• Brain stem involvement (HSV, ENT 71, WNV)
• Cerebellitis (VZV, EBV, mumps)
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Neurological involvement
• Diffuse:
• Meningitis
• Encephalitis
• Localized:
• Brain absces
• Subdural, epidural absces
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Focal CNS syndromes
• Clinical presentation depends on:
• the route of spread of the infection hematogenous x direct (trauma)
• location of the lesion
focal neurologic finding: stroke syndrome, pareses to complete paralysis
• severity of increased intracranial pressure
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Differential diagnosis• Other infectious syndromes:• Parameningeal foci or infection (brain abscess,
sinusitis, otitis, mastoiditis, subdural or epidural abscess, venous sinus thrombophlebitis, cranial osteomyelitis)
• Infective endocarditis• Viral postifectious syndrome• Postvaccination (mumps, measles, polio, pertussis,
rabies, vaccinia)
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Differential diagnosis
• Meningism = triad of nuchal rigidity, headache and vomiting → irritation of meninges
• „Meningismus“ = symptoms are present without actual inflammation of CNS
• (other acute illnesses in paediatric population: viral or bacterial, febrile status)
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Postinfectious meningitis
• Neurologic involvement develops one to three weeks after the illness (measles, rubella)
• Destructive CNS inflammation is caused by autoimmune mechanism similar to postvaccination involvement.
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Noninfectious diseases
• Intracranial tumors• Medications (ATB, cytosine, azathioprine,
phenazopyridin, immune globulin)• Systemic illnesses (lupus erythematosus)• Procedure-related (postneurosurgery,
intrathecal injections, spinal anesthesia)• Miscellaneous (seizures, migraine or
migraine-like syndromes)