• History and Physical Exam Findings for Meningitis
  • 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

• Head CT Before LP only beneficial if....
  • 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

• Empiric Antibiotics for Meninigitis (IDSA guidelines)
  • 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

• Dexamethasone for Bacterial Meningitis
  • 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

• 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

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Created by Christopher Kelly
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.