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CNS Infection

6. RECOGNIZE THE CLINICAL MANIFESTATIONS OF ABSCESS AND FOCAL INFECTION DUE TO LOCAL SPREAD, HEMATOGENOUS Disease ASSOCIATED WITH IMMUNE DEFICIENCY OF CNS INFECTIONS and how they differ from the MIMICS. CNS Infection. Four cardinal manifestation. LOCATION. Meningitis

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CNS Infection

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  1. 6. RECOGNIZE THE CLINICAL MANIFESTATIONS OF ABSCESS AND FOCAL INFECTION DUE TO LOCAL SPREAD, HEMATOGENOUS Disease ASSOCIATED WITH IMMUNE DEFICIENCY OF CNS INFECTIONS and how they differ from the MIMICS

  2. CNS Infection Four cardinal manifestation LOCATION Meningitis Inflammation of the subarachnoid space. Encephalitis Inflammation of the brain parenchyma Meningoencephalitis Meningitis and encephalitis occurs together. • Fever • Headache • Alteration of consciousness • Focal neurologic signs

  3. Encephalitis Bacterial encephalitis • Meningoencephalitis - occur as an extension from meningitis • Abscess - focal/primary infection within brain parenchyma, typically surrounded by vascularized capsule • Cerebritis – non capsulated brains abscess

  4. Cerebritis Early Capsule Formation Brain Abscess Late Capsule Formation

  5. BRAIN ABSCESSETIOPATHOGENESIS

  6. PREDISPOSING CONDITIONS AND LIKELY PATHOGENS IN THE BRAIN ABSCESS Predisposing Conditions Likely Pathogens Ear infection Anaerobes, gram-negative aerobes (Pseudomonas, Proteus), streptococci Hemophilus influenzae (children) Dental, sinus, Streptococci, anaerobes, Nocardia, mastoid, and staphylococcus pulmonary infections Trauma, surgery S. aureus, S. epidermidis, gram- negative anaerobes Abdominal, pelvic Anaerobes, gram-negative aerobes, infections streptococci

  7. PREDISPOSING CONDITIONS AND LIKELY PATHOGENS IN THE BRAIN ABSCESS Predisposing Conditions Likely Pathogens Endocarditis, S. aureus, S. epidermidis, gram- parenteral drug, negative anaerobes, streptococci, usage, fungi HIV/T-cell dysfunction Toxoplasma, Aspergillus, Candida, Nocardia, mycobacteria, Listeria, Salmonella, Cryptococcus Neutrophil dysfunction S. aureus, gram-negative aerobes, Aspergillus, Zygomycetes, Candida

  8. Brain abscessclinical manifestations CLASSIC TRIAD OF: COURSE At onset, headache, vomiting, convulsions as the abscess progress, neurologic signs become readily apparent papilledema lateralizing signs e.g. hemiparesis, homonymous hemianopsia more obvious signs of increased ICP insidious onset and slowly progressive sudden rupture sudden high fever meningeal signs deterioration of consciousness

  9. Brain abscessclinical manifestations • Headache (constant, progressive, refractory to therapy) - 70%-90% • Fever (low grade) > 50% • Focal Neurological Deficit (FND) 60% • Nausea & vomiting (due to inc. ICP) 25%-50% • Alteration in LOC 66% • Seizures 30%-50% • Papilledema & meningismus < 10%

  10. Brain abscessFocal neurologic deficits

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