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CNS infection

Learn about types of CNS infections like meningitis and encephalitis, their clinical features, common organisms, diagnostic approaches, and treatment options as outlined by Dr. Hazem Alhewag in this detailed guide.

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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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