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CNS infection

CNS infection. By Dr: Hazem Alhewag. Types of CNS Infection. Meningitis : Encephalitis Local suppuration. Meningitis. Acute meningitis. Age of onset: Children, young adult But must be suspected at any age in immune compromised patients as…….. Routs of infection: Blood stream

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CNS infection

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  1. CNS infection By Dr: Hazem Alhewag

  2. Types of CNS Infection • Meningitis : • Encephalitis • Local suppuration

  3. Meningitis

  4. Acute meningitis • Age of onset: Children, young adult But must be suspected at any age in immune compromised patients as…….. • Routs of infection: • Blood stream • Direct spread from local area • CNS surgery or trauma

  5. Clinical features: • Symptoms: • Fever • Headache • Vomiting • Increase ICP • Confusion, delirium , irritability, disturbed level of consciousness up to coma • Seizures ± Focal neurological deficits • Signs: positive meningeal signs( Kerning's , Brudzniski neck signs and Brudzniski leg signs

  6. Organism • Common organism in children • * E. coli * Streptococci * H. Influenza • Common organism in adults • * Meningococci (commonest) * pneumococci • Common organism in elderly: • * G –ve bacilli

  7. Suggestive features of meningococcal meningitis. • Typical rash appears on the trunk, legs, palms, soles, conjunctiva and mucous membrane ranging from purpura and extend to become bullous lesions • DIC • Aderno-cortical insufficiency lead to cardiovascular collapse • Myocarditis, pericarditis and arthritis

  8. Chronic meningitis • Septic meningitis: • Causes: • TB meningitis • Viral meningitis” HS,CMV” • Fungal meningitis • HIV • Other rare organisms AS Spirochetes

  9. Aseptic meningitis • Carcinometous meningitis • Cranulometous as sarchidosis • Vasculitis “collagen disorders”

  10. Clinical pictures of chronic meningitis • subacute onset slowly progressive course of headache, malaise, increase ICP. • dementia, with polyneuritis cranialis which show great affinity to affect the base of skull , the most common cranial nerves are the lower 4 CN, optic and olfactory. • signs of meningial irritation. • Fever usually absent • Sings suggesting A\E as in TB, or Malignancy

  11. Viral Encephalitis • Acute viral encephalitis • Post infective encephalitis “ remote manifestation after infection “ measles” • Prion diseases : Ataxia , myoclonic epilepsy , demantia

  12. Viral enchephalitis • Clinical picture: • Fever • DLC • Seizures

  13. Common organism • herpes simplex, herpes zoster, CMV, mumps, measles, HIV, Arbovirus, West-Nile virus) • HS : characteristic features due to predilection of temporal lobes involvement

  14. Diagnosis of CNS infection By CSF

  15. Other investigation • CT & MRI • EEG • PCR • Antigen detection

  16. Investigation & treatment

  17. LP suggesting encephalitis • Start treatment by: • Acyclovir & antibiotics : Acyclovir IV 10 mg/kg tds and do PCR for Herpes virus: • if positive → continuation ttt 2-3w • If negative stop ttt

  18. LP suspect meningitis • Cefotiaxione or cefotaxime IV 2g /day for 10 days of afebril state • Ampicllin IV 2g if suspect liseteria Age >55y • Add steroid if suspect pneumococal infection for 4 days

  19. Complication • Seizures • Hydrocephalus • Dementia • Abscess • Infarction

  20. thank you

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