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- Classic triad of fever, neck stiffness and AMS or HA --> 99-100% of patients with meningitis have at least 1 of these findings
- Brudzinski's Sign - patient's neck is flexed by physician and patient will flex their hips and knees (Sensitivity of 97%)
- Kernig's Sign - physician's unable to extend patient's leg at the knee when thigh is flexed (Sensitivity of 57%)
Posted 10/19/16 09:06:54 AM by Ying Liu
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- Immunocompromised State
- History of CNS Disease
- New Onset seizure (within 1 week of presentation)
- Papilledema
- AMS
- Focal Neurological Deficit
Posted 10/19/16 09:08:21 AM by Ying Liu
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- Third-Generation Cephalosporin with good CNS penetration (Ceftriaxone) to cover common pathogens including N. meningitidis and S. pneumoniae
- Vancomycin to cover resistant S. pneumonia
- Ampicillin to cover L. monocytogenes in those <1 month and >50 years
- IV acyclovir for encephalitis
Posted 10/19/16 09:13:29 AM by Ying Liu
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- Must be given before antibiotics
- Benefit is seen at 8 weeks --> decreases unfavorable neurological outcomes and death
- Only beneficial in those with pneumococcal meningitis
- IDSA guidelines: Give in adults with suspected or proven pneumococcal meningitis. Only continue if CSF gram stain or blood/CSF cultures are positive for pneumococcus
Posted 10/19/16 09:15:59 AM by Ying Liu
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HSV Meningitis/Encephalitis
- HSV1 is associated with oral lesions and is more likely to cause encephalitis
- HSV-2 is the cause of most genital infections and the cause of most causes of viral meningitis in immunocompetent hosts
- Associated with recurrent aseptic meningitis previously classified as Mollaret’s meningitis
- Can be associated with neurological manifestations such as seizures, hallucinations and CN palsies
- Valcyclovir therapy can be used to treat HSV-2 meningitis and suppressive therapy can prevent recurrences (although no consensus on who would most benefit from therapy as most cases are self-limited)
Posted 10/19/16 09:17:25 AM by Ying Liu
Created by Christopher Kelly
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