Dr.Rakesh TP
Sr. Lecturer in Medicine
Terms
Meningitis
Encephalitis
Cerebritis
Abscess
Classical signs
Neck rigidity
Kernig’s sign
Brudzinski’s sign
May be absent in
Extremes of age
coma
Immunosuppressed
ACUTE BACTERIAL MENINGITIS
Acute Bacterial Meningitis
Acute purulent infection within the
subarachnoid space
Predisposing conditions
• Pneumococcal pneumonia
• Sinusitis or otitis media
• Alcoholism
• Diaetes
• Splenectomy, Hypogammaglobulinemia
• Complement deficiency
• Head trauma with basilar skull fracture
and CSF rhinorrhea
Nasopharyngeal colonization
L. monocytogenes
Increasingly important cause of meningitis in
neonate, pregnant women, >60 years, and
immunocompromised
Contaminated milk, soft cheeses, and several
types of fast food
Staphylococcus aureus and coagulase-
negative staphylococci
• Prevention of Phagocytosis
Immune response
Causes of Stroke
Cerebral vasculitis ischaemia and infarction
Thrombosis of MCA
Thrombosis of the major cerebral venous sinuses
Thrombophlebitis of the cerebral cortical veins
Cerebral edema
Combination of Interstitial, Vasogenic and cytotoxic
edema
Clinical features
Classical triad
– Fever
– Headache
– Neck rigidity
Other symptoms
Nausea, vomiting, altered sensorium,
photophobia
Seizures in 20 to 40%
Focal seizures
• Focal arterial ischemia or infarction
• CVT with hemorrhage or focal edema
Rash of Meningococcemia
Diagnosis
Once clinically suspected….Take Blood
sample for culture and start Empirical
antibiotic…
Imaging
Differentiating points
1. Prominent altered sensorium and seizures
Hospital-acquired meningitis,
posttraumatic or postneurosurgery
meningitis, neutropenic patients, or
patients with impaired cell- Ampicillin + ceftazidime +
mediated immunity vancomycin
Ceftazidime should be substituted for
ceftriaxone or cefotaxime in
neurosurgical patients and in
neutropenic patients
Specific treatment
N.meningitidis
Or
Penicillin-sensitive Penicillin G
Penicillin-intermediate Ceftriaxone or
cefotaxime
Penicillin-resistant (Ceftriaxone or
cefotaxime) + vancomycin
Repeat LP at 24 – 36 hrs
Gram-negative bacilli (except Pseudomonas
spp.) Ceftriaxone or cefotaxime
S.pneumoniae 2 weeks
Listeria 3 weeks
Raised ICP
Head raised to 30˚ - 45˚
Hyperventilation
Mannitol
CSF culture
Serology
Differential diagnosis
Bacterial meningitis and other infectious
meningidities
Neoplastic meningitis
Measles
Mumps
Polio
Varicella zoster
Prognosis
Excellent in adults
Occasional sequel in infants
Subacute and chronic meningitis
M. tuberculosis
C. neoformans
H. capsulatum
C. immitis
T. pallidum
TBM
Subependymal caseous foci cause
meningitis via discharge of bacilli and
tuberculous antigens into the SAS
Hydrocephalus
CSF
Elevated opening pressure
Lymphocytic pleocytosis (10 to 500 cells/uL)
Elevated protein concentration (10 to 500
mg/dL)
Decreased glucose concentration (20 to 40
mg/dL)
“Cobweb”
Steroid
Supportive measures
Cryptococcal meningitis
Association with Immunodeficiency
Lymphocytic predominance
Read in detail…
Herpes simplex meningoencephalitis
Cryptococcal meningitis
Chemoprophylaxis