Neurology: Neurological Infections



This session on CMS infection will provide an overview on the topic and encompases bacteria, virus and fungal infections, the age groups they most affect, and common treatments. Discussion will also include symptoms and differential diagnosis, including the triad of fever, neck stiffness and altered mental status, as well as the particular rash associated with different species. Opening pressure and CSF investigations will also be covered, as well as post-infectious conditions such as encephalitis, contributing to a better understanding of this complex area.
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Learning objectives

Learning Objectives 1. Describe the anatomy of the Central Nervous System (CNS) and its potential to be affected by infection 2. Distinguish between bacterial and viral CNS infections and their respective treatments 3. Identify signs, symptoms, and necessary examinations for a diagnosis of CNS infection 4. Discuss the difference between meningitis and encephalitis, including the common pathogens for each, and their respective treatments 5. Explain the indications for use of dexamethasone in a CNS infection situation and its efficacy
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Oh, everyone. Thank you for joining us for today. And thank you for having me. Um, I'll be talking today about, um, CNN's infection. Um, so let's start it. My name is jihad on a more of a neurology. Three me in the hospital. So, brain, uh, is obviously up. It could be affected by, um, infection. Has any birth before off or bodies on? Um, this coverage from bacteria virus guy or even for a side on that serious infection sometime might be tricky to diagnose. Uh, might be difficult to recognize. The patient was having the symptom on, uh, and sometimes most of the time, they don't fulfill the criteria on, but it's really neat. Hi. Chemical suspicion for four to be diagnosed. So try today to cover Mean it is a really blotchy rash topic. So I tried my best, uh, to summarize it. Hopefully you will get the mean, um, point will help you with your basic, um, date. They work. Um, so let's start, um, when we talk about the listen fiction, um, that's includes the brain. Quickly. Just simple answer. Will, um, spinal cord's optic nerve's on the covering members on again. What has been involved in this, um, teaching, because it's it's very important, um, topic to talk about a cyst as infections and Medicaid emergency on if not treated well, it can lead to substantial morbidity and mortality on long term secretly. So we'll be covering today, uh, the mean CNS infection. So the big board, the division, including ritis, think it'll like this on brain abscess. So let's start with meningitis as we all normal. And dryness is the inflammation off meninges on binges covering the brain. So inflammation many drive is is basically and inflammation of the rain coming. So it's not so the infection does not involve the brain itself, just the liars on. But we'll talk about this later on. But we know why. This is important to recognize on any, um, organism can cause meningitis brain you from bacteria, virus, fungal. Sometimes meningitis can being on infectious, but will not be talking about this on to the session. Yes, meningitis is a rare, um, infection, especially after, um, vaccination. But it is serious infection. That's why we need to know about it. So how do we get meningitis? Um, we can encounter the infection either Phone blood born spread. Or we can get it from direct the spirit. If we have infection nearby on off, you see by need by we talking about the the infection or see must diet is or this fracture or any impairment or hold that allowed the bacteria or the infection to inter the brain. I could be from colonization from, um, foreign body in the brain like implants or shots. So how do you know what this patient is having been in George's? Uh, everybody's aware about the Triad off Had aches next, deafness in after sensorium. But again, as I said that it's not that straightforward skin, um, medical practice on it needs hygienic. It's suspicion. Um, so the the minutes lives in this in this presentation or Benny table. It can be crowded and messy, but some of this table really nice and summarize, um, the topic. So as it this stable, um, talking about, um, be a group that's affected by the infection on the treatment for it. And why would why won't divided me this way because some infection is coming in the specific age group. That's why we use a specific medication to cover for it. So if we ignore the new names in the infants and start from the others, we all know meningitis will be treated by two grandkids tracks on two times a day. On Why is that? Why is this choice? Because the common infection bacteria that causes meningitis is streptococcus me on my cereal. On the other option that listed here. Not coming the use. But we can add vancomycin, especially in Immunocompromised station, or for a specific situation. But in generally we use kept track soon for treating bacterial meningitis on you can see an elderly cool. Um, one of the option ampicillin has been added on. The reason is another bacteria is appearing here in the common pathology in which is the stevia. So if you have patient more than 60 suspected meningitis on before receiving the culture sensitivity or it's better always toe team on ampicillin on. As we said for immunocompromised, we need more coverage on for over a complicated meningitis as most brain surgery or atypical and enjoy this. So I'm just talking very quickly about that for common bacteria that causes meningitis. Um, Percocet me is the most common bacteria associated with many dry. It is on usually even just is a one off. So you think get recurrence meningitis. Unless this for specific patient and it is a reason for it and the most common cause of recurrence issues. If league is this to talk this no money on obviously or infection increase in HIV and a new deficient patient on as we almost come on in winter. Overcrowded environment as daycare for Neisseria a strong what she said Negative. Typical guy and the infection are usually countered by contact with trouble. It it is the second common on because off bacteria and meningitis Um um, the differentiation off my Syria is, um, finding rash on examination, which is a a famous particular rash. Uh, and that's serious because it can lead to for minutes at the I see on, then kill me. To him, allergic causes adrenaline. So that's why it is that it's very important to be recognized and treated. So that's the rash we just talked about. Um, is start very. Come on, let me stop associating with all they said. Yeah, I try to, um, emotional state flow is a is a grand negative. Colossal eye on. Do it now is is becoming less come on, especially after the production of his vaccine on the school is, um, you know, come from my station, we'll take a reason Karnik Disease or 20 on Lawson Listeria. As we said, it's it's mainly infection off. Elderly is group at in general other. It doesn't cause symptoms except thought mostly even compromised patients on they have been outbreak associate it with, As we all know, this'd be associated with a specific type of food as unpasteurized milk or undercooked meat or chicken. So now, with suspecting this patient is having many try this A Z say it either coming with the triad off fever, neck stiffness after sensorium on headache. Oh, and the patient is septic. Uh, how be how do it each day? Noses. Obviously you need to investigate in the war Lantus for all septic patient. But the cannot that was been in drugs without having a CSF examination on. I know it is, um, invasive procedure. And no one like the patient with the doctor that it is Amanda city. Um uh, this to the nose meningitis. So we're doing love off a blood puncture on a patient for big news is you have to do opening pressure. And this is, um, a tip that I'm giving to you because most of the time for meningitis just go. For now, said cons on 14 from stand both opening pressure is a very important part off CSF. And then this is, um so you send for the usual glucose paired with serum protein, but the cell count on gram stain on Penis send virus is er four or our cases of suspected meningitis. Uh, do we need to do a brain image four minute drive. This patient, um, for diagnostic purpose, it's really add a little benefit, but we usually do it throughout. Other difference yet, and I don't think anyone would be really comfortable doing a lump of function Now. See, making sure there's no contra indication on the brain is not, um, tens. Um, and again, we can do it looking for complication. But in case of meningitis is not really helpful for diagnosis. So they're specific, um, reason for doing print imaging, porting toe infection, disease association, America. Um, not sure this about to you, for you. Okay, but in general aside, says no one be really comfortable doing a CT head, so you need it mainly in immunocompromised vision, as we said, because they are the many of a differentiation this history of Sinus infections or recurrence. Again, there's a suspicion if you have a seizure again, with suspicion off the friendship for can urology, abnormal GCS and probably Dina on these, the last two responsibility off having high intracranial pressure on this is obviously contraindications for doing good. So this another table very helpful. So it's very basic. But tell pink to differentiate in general between other causes for meningitis. Um, so, as we said, we look for opening pressure, such count on glucose and protein. Um, and the Toprol. We can see this the normal, the normal values. So said Count aloud to have five lymphocytes. So if I have someone has to be emphasized, it won't be anything else. Um, usually, cell count is really high in bacteria infection on mainly for more, with low glucose and high protein on again, just as you can see us to differentiate between which type often in drive this onda again, you can differentiate by for fungal and bothering both, causing you for side. But series of 14 is usually innovated and fungal meningitis, but usually normal environment Enjoy this. And this is doesn't have is not a a little, but I help us to reach the diagnosis. Um, I think that's the same table food talked about earlier. So, um, this is doing us about the, um, treatment on for all others you treat with ceftriaxone to ground twice. Itty on the add. Um, selling for overly patient like wasting can be added for compromise. Patient on it is unusual noise once were tracks one. So how about dexamethasone? Do the Axiron to allow, um, patient with enjoy this. So in pediatric, maybe. But in others, um, it still is, Didn't show much evidence, or there's no difference in a long in the outcome except little evidence supporting decrease complication. But there's no much evidence off using it, especially in, uh, uncomplicated. Meningitis on, if it has to be given, has to be given with the first or before the first those off antibiotic. So it's as early as Byetta. I'm the treatment we talked about covering bacterial meningitis. So what do we do with fire? A meningitis? So far? Um, in in drug, it's usually the patient and being unwell wasn't having headache and fever Both. There will be less at sick clinically bacteria case. Yeah, sorry for the interruption. So we are talking about vitamin Enjoy. It is, as we say, they should be less symptomatic with it. And the treatment usually conservative for finally enjoy. This is not something you see commonly on. Usually see it with immunocompromised patient on. If we if the patient immune compromise on regarding the CSF analysis was suspecting fungal infection, then we have to add a fortress. See? So moving to in Keep it like this. Uh, why This is different Because in flight, this is the inflammation of the brain itself. Oh, on again can be caused by all infectious agents from viral bacterial oversight. That as well No, the famous because four. What is his house? I'm And this can be post infectious on does usually happen because of free activation. Off new new issue on again the most common viruses. Two goes. This is heavy on various and this was two. On the famous are post infectious colitis. Brain infection is a team. We see that mainly in young adult and each other and the last form of thing. Careful eye is the one effectual is one on this can be caused by metabolic toxin, autoimmune or burning prostate. But again, because this was since affection know be covering this part Indian to the session. So how the patient in detail eyes is present because in flight is is the infection of the brain tissue the presentation besides the fever and Subsys, the bent on the area that's infected in three on because we said her is the most common virus cause meningitis and how this is famous off infecting the temper. That's why most patient with me for, like, this present with temporal lobe abnormality in form of personality changes that causes, um, hallucinations. So, uh, disable helpful In summarized, the, uh each focuses on did management for it and also talking about presentation. So her this we just talked about that causing still look, you, Maliti and, uh, you can go seizure. The treatment for it is usually as exactly pertinent. Remember kg every varicella so so cysts can come cause for viral meningitis on the treatment is are the same. We have different viruses that can cause meningitis, but we don't encounter of them are commonly in practice as we say it mostly, you know my patient. So I know this is very small writing on annoying the ground, but I find it very health one in diagnosing patients think about especially, ah, before junior look So yeah, and uncle setting. So if you have a patient was showing signs off in July, it is as in altered for mental state. New seizure, fever header. And you suspected meningitis. Then what do we do use over your season for not this on as we said, we cannot ignore since infection with them without having CSF analysis. Um so can we do CSF? No contra indication for lumbar puncture. Then yes, we go ahead with our puncture on send for the more kids that we agreed on earlier. If we cannot do number function because off any contra indication, then we just go on treat as we say it with a cycle over on the The part that is not showing is if the reason is not clear for the colitis. Then we proceed with the MRI. I'm asking for infections. Disease consults in someplace. So speaking off them or I, this is an MRI for a patient with income forties. And as we can all recognize, the abnormality in the left temporal, um, on MRI. Not like in meningitis. Brain imaging is, um, very helpful on a part off the ignore zing Sinus infection. So again, if you don't sure about, just proceed with a scan on your CT brain or MRI. Brain on a third of a diagnostic approach is doing an e g and why we're doing energy. In some cases that not clear because they help us with big noses, especially if you have patient that are not waking up with sepsis and nuclear source of infection. You can diagnose, especially, is having seizures and convulsive status. And this with infection again point to a Sinus source of infection. So how do we treat? Obviously, we need to give supportive management for all the patient on the main stay off treatment off in compliance is a cycle for on go by 10 mg per kg are three times a day, and obviously we changed. We lower the doors toe arena. Those if there is, um really parents be third. Um, mean writing for CNN's infection is brain abscess Uh, and were these brain abscess Access is an access everywhere. So brain abscess it the pain localized suppurative infection, um, in the brain during chemo on how does it happen? So again, the same process of abscess will be for inflammation on Dema, which is a really surprises, uh, which later, on the toe, wider inflammatory response with necrotic call, which is later brightest. And this can be a few weeks after the first stage and then later on this would be surrounded by collision ist capsule. So what are the causes of brain abscess? How do we get the brain abscess? Um, usually the most common way off getting different infection is from spreading affection from nearby structure some same like and middle year old chronic sinusitis or even dental abscess. Another way of getting it would be through him. Achiness spread on him until June. It's spread, usually the remote. A Bill abscess is not a single one on, but usually they follow a vascular distribution. So we're talking about the main causes off brain abscess. It's usually stuff, always or strep trickle on quarter of patients might have pulled a micro micro, um, in the coalition for abscess or in the culture later on. Other unusual causes for abscess could be found being, uh, the new complete manifestation. Um, so how this patient with abscess present again? That is a triad of fever, headache and Focalin allergy on. As I said, the truth classic features doesn't have to be present in every patient. Um, obviously patient, our septic. So they come with fever. By God, they would have see a seizure as well. And also level, of course, is Nece. So how do you diagnose abscess? And this is the first infection. I have to say you need to do a CT scan or MRI. Brain imaging cannot diagnose been abscess clinically or by blocked. Us are only you need to confirm that with brain imaging. Obviously, MRI is usually soup in here to city head on. How the how the abscess look like in a scan. It's usually abscesses, a ringing house lesion on the MRI on, um, surrounded to be any chronic tissues around the boy on variables on video. So this is how I just looked like on, uh, as we see this is multiple abscesses. Bring enhancing lesion in there, and how the radiologist differenciate between other cause offering and house invasion by doing other sequences in the American as jury. This case, uh, which differentiate between other course, the similar age. So again, we always need to do something quicker for us of the patient, lumbar puncture is not really helpful. That can be contraindicated in access patients. And even if we do it, for whatever reason, we say that if we show makes a make sure off your side towards is on prices a routine culture, usually nature. So how do we treat brain abscess? Um, it is a combined, um, approach. We need to help off our, uh, neurosurgical colleague. Uh, we usually cover the antibiotic for the spectrum antibiotic, but obviously, we need to drain the abscess on the best way flowing system Doctor committed abscess, Aspiration City or whatever the surgeon decides to do so before moving on. Um uh, just we may have a slide about contraindications for liver function. Tests were happened with that, but in generally, the perfection is very important for you. Diagnosing this infection as an as acidic or contraindications is evidence off having and decreasing trick and pressure either through doing city had all thinking, If patients very low, gee says on, obviously, if there is infection, the lesion off the after the the lesion off the number puncture, or that if it is any quack, you're busy. And so there's any reason that would delay patient of having number function. Then you have to treat. So as we all know, the General Do you suspect scenes Infection, If you suspect enjoy it is you have to treat on you start American therapy. Um, the therapy you agreed to on yes, three beats and starting to attic might reduce the result of having was it the blood culture, but almost 15%. But again, this is the important and for patients. So I thought about also talking about my question infection because my question you affect the Sinus in many way. Um, they can cause tuberculosis meningitis, and we already talked about to park listening dry. It is, um it can cause tuberculum A, which is begin special coupon vision and can behaves in like abscesses on it can affect the spine causing destruction to the spine Ankle abscesses. So how did they diagnose the mycobacterium? We go through the same rule by doing CSF an examination. And as we said, we'll have high lymphocyte on low serum low because and high protein and gold standard is culture. Um, usually sent culture for gram stain. But if there is any suspicion off your back last minute drive this. We should add a Citrus positive light or signals and stay. And again you treat if you suspect, and then imaging almost healthful our brain or swine, depending on the presentation off. Differentiating how b B which time off infection we have. So this it's kind, showing us multiple jibber Coloma That's the biggest one that we can see is multiple classifieds, our other smaller lesion. And this MRI shows your off involvement off spine. It's the common and usually at for a thick spine, But, um, it kind of affect anywhere. There's no there's no room, Um, and causing called abscesses were. So how do you treat like a bacterial meningitis? Or I could the infection In general, we was at the chewable just medication on as a like about the infection anywhere we go for three agents when it's warm applause. Fourth Agent, um and always don't forget to add steer Oh, it's for my back three minute drive this on what it looks like then worse. Or surgical intervention? Yes, especially if it's pressure seem to a mass effect from the Children Coloma or obviously for C spine and closes. Uh, the bed also might be infected by rare on uncommon and organism. On this is Milly common in HIV. Or if you look from my special in genera so we can have unusual vital and some guy or even a side effect in the brain. Um, who was final court and sometimes infections. I happened because off reactivation off late ladies and pathology has been there nobody the whole life and then reactivated with the new system weight down as JC virus still briars cytomegalovirus and talks to us. Um, you cannot talk about, um, you know, from from my station got national Our office artist is an immune reconstitution inflammatory central on usually happen because off exaggeration of activation of the new system response to treatment of infection immune compromised patients. So breath OxiClean worsening off infection for initiation off therapy in especially, and try chivi patient. So usually we encounter this inpatient and your client it closes took up can meaning drive this or PML, which is the JC virus infection on toe. Avoid this or even to treat it. If it's already happened, recover a patient with a steroid it. So, as we say, the story can be indicated in specific, um, situation in CNN's infection again, another historical infection. But we cannot cover CNS infection that we're talking about syphilis on syphilis is know that come in since you see this penicillin on um neurosyphilis become now existing. This is with the Tri VI patients. So, as I said, it's mostly in it. In the immune, compromised patients on a surface can infect the brain either every own or later stage, so a really neurosyphilis are usually present. The civility community drive this, and and usually it's early on, the first month of infection and the patient present similar as meningitis with headache, photophobia and friend in there. Also this time on, also for syphilis is famous off, infecting the eye so minus ocular your tractors and the other way that surface affecting the brain is laid. New syphilis on um, this usually happen very late in took him. I take 5 to 20 years for 40% on it can present in three different way as the hospital syphilis, saying It's Coomer's on the store sells. I will not go into detail off that because of the different, But we just need to know that so flys can affect the brain out. Other. Any station late stage on How do you diagnosis the usual really diagnosis The fist fight with your all test on day. If that's the common and reactive the ocean off serum to believe in test and if again, high suspicion, everything is coming back negative. Then you have to do a CSF on as we all know, the treatment for this virus energy Lyme disease is a line is another. Unusually, CNN's infection are causing by one spiral Great, uh, really up to four on, um, they obviously the same time. The patient experience, because of the immune response to it on Lyme, have three stages through the localized L inseminated on Corning disseminated. Then, if the only disease is just a rash, it can be self limiting on. Kim just go without any infection, but the patient mostly remains zero positive on the second stage, moving all body and again patient can respond can resort the symptoms resolved without treatment. But if you if you don't treat the patient, the expired red becomes frustrated in organs include within the brain on the third the situation arthritis. So how does, um, poorly a infection is on with this law? I mean, so, like, I'm usually, um symptom Usually took take more than a year for a minute. Just askin this infection on, um it can cause literally everything I can affect the brain by enemies causing speech problem weakness kit Difficulty. A taxi, um can affect the spinal cold can affect the fish with disturbance on more sleep. Uh, so if if you have a patient with complicate or neurological presentations that does not really a explained by one both ology. You can always search for Lyme. How did investigate for line? Why again? See, it's f 41 CS infection on line that would be receiving SSI toes is really monocyte on a high protein Egion city are usually help us to diagnose. Why is he is on again? Because we said like can cause everything in the CT. We can see multiple and fork cerebral atrophy on um white matter abnormalities in the MRI, which should be very specific. So again, this is need the high chemical suspicion, and sometimes you need to go back and ostentation multiple time about take quite old if they have bean where in any as that is endemic for mild disease. How do you treat line by early on my doxycycline? Really? If it's the diagnosed and treated early on late, we can try on tricks. On alternative will be insulin and doxycycline. Obviously, in its stages, there is treatment for your reporting so on the coffee or measures in its infection without talking about college onda. Although we don't have enough data bit covered, report to affect it affects it is, um, as over our organ in your body on it's mainly these are complication from coughing infection so it can affect the brain by enemies, because in the right ear's in Cholitis Park, it's in your future Alzheimer on stroke from him, recheck or ischemic seen. Both cases on the violin nation can present to a seizure would even psychiatric and if it's station on, obviously all come in contact with Long conference, which is causing Vexus symptom, which can involve neurology as well in form of just a memory impairment. Very vague symptom off numbness here and there. So, uh, covered for sure can cause some seeing this manifestation. So I guess what I need to say from this presentation is Sinus infection. Serious on need, engine hygienic suspicion and a restaurants management on If you suspect you just treat if there's any delay because of no one is trained to puncture or we can do the scan. Hi, I'm are really just treats. And then deal with that, ain't it? I'm You need to think about Sinus infection in any septic vacation with no clear source on especially this abnormal neurology examination organ. It's safe for a seizure. But obviously you don't just treat all of the lien patient with a Sinus infection, so it could be sometimes tricky on an immune compromise. You noticing wider. Unusual because they can have our 80 begin bacteria. Let's begin infection on vice versa. So if you see on 80 begin bacteria and need to check for HIV or check for any reason for your compromise, thank you all for listening on really to think any question. If you have really Thank you so much. Do you How it again? That was really, really good overview of what is a very, very broad Top it even getting some of the more, um, games or some of the more nation factions that I have to say coming from south debited syphilis is actually on the rise for various various reasons related. I'm not sure about around London with you, Terry. Know, I get my knowledge of the not my knowledge of the specific separates dynamics in my area. It's not. It's not sort of on point that I'm sure you have maybe have you see a a separate case? Is that so? So, yeah, I was about to say from my mean, I will see minimal experience, really having I haven't seen any stiffness. Patient. Really? Ah, but, uh, I may be new syphilis for, say, is not that common, but I'm sure there is many selfless patient. I mean, if yeah, I mean, if er getting smallpox rated for us is appearing. You came a We're about to get through Renee, Sons of things like play consider. Well, yeah, I actually have. I just have one question would be caught technical but in terms of diagnosing me, be the immune suppressed people just ah, because it's seven for triplet virus. Anyway, how would you have? Is there any way that you can tell whether it's the e B B? That's the court there, whether it's this or bystander, Um, where is that? Probably bit, uh, well, I mean, that job gets just a short answer is Well, I'm not sure, really. Does it tend to cause a different syndromes? Or is it just like the patient seems? Generally, I'm well, like they would, you know, try the patient. Yeah, Yeah, HIV where the cause is. And that sort of the HIV itself. Um, well, I mean, I was in a Tri VI patient. If they ever have a workable medication, very compliant and everything. They don't usually encounter this Unless they are. They stopped the treatment or CD. Four count is really dropping. Any know? But, um, So I'm thinking if you have a patient who just has, um, you know, compromise and you're sending happy came in with Sinus infection. Um, so I think my messages need to check for other unusual because off, off, off since infection, If everything is becoming back. If the culture and everything coming back negative, then could it be the unusually fiction A society? Me gonna fire 16. But I'm a questionable for what, exactly? Specific tests to confirm it. But I'm not. I don't Not exactly sure. Yeah, that's right. This, uh, no interest. Okay. Doesn't look like we've got any questions coming. Three. Um, have you had in Washington? Put the feedback from there we get Yeah, we can get. You can do it by the QR code as well. But if we just be that up for a minute or so Sure, you can either provide feedback by the There's a new button in the chat which we compressed. You can get a copy of the presentation. We don't We try and get out within a couple of weeks on like Terry. So at the beginning, although recordings and normally we had a bit of an issue with the acute straight one, but it's resolved, but well, the recording to definitely go up within 72 hours. Thank you for everyone who's attended today. And he's attended the lost 10 also session