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o Complications:
! Seizures, subdural effusions, SIADH, prolonged fever, DIC
o Sequelae:
! Cerebral atrophy
! Microcephaly
o Treatment:
! Uncomplicated penicillin sensitive s. pneumonia mengitis: 10 -14 days
! Resistant strep: vancomycin
! Uncomplicated N. meningitides: IV penicillin 5-7 days
! Uncomplicated h. influenza type B: 7-10 days
! Gram (-) meningitis: 3rd generation cephalosporin
• Viral Meningitis
o Aseptic meningitis
o Usually accompanying the viral infection as diarrhea, respiratory, mumps, measles, varicella
o Treatment is supportive as the course is self-limiting
• TB meningitis
o 3 stages:
! Stage 1 –prodromal (fever, headache, irritability)
! Stage 2 –neurologic signs (meningeal signs, decreased level of sensorium)
! Stage 3 –coma, irregular respiration, rigidity, opisthotonus
o Diagnosis:
! Clinical: subacute course, (+) exposure to TB, (+) tuberculin test
! CSF: groundglass apperance with tendency to coagulate, increased WBC with
lymphocytes, extremely high protein, low sugar
! (+) Acid fast staining, PCR, ELISA, or latex agglutination antigen
o Treatment:
! Quadruple anti-TB regimen:
• 2 HRZES/ 10 HR
WBC Protein Sugar Others
Normal 0-5 lymphocyte 15-45 50-75 Clear
>50% of blood sugar
• Encephalitis
o Usually viral
! Herpes Simplex
! Dengue encephalopathy
! Subacute sclerosing paraencephalitis (SSPE)
• Related to measles
• Subacute and degenerative disease of the entire brain
• Symptoms: behavioral and personality change
• Diagnosis: (+) measles antibody in the CSF, characteristic EEG findings
• Treatment: no treatment