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Definition ~
*Meningitis ~ inflammatory process involving the
subarachnoid space, pia and arachnoid matter
(leptomeninges)
fever, headache, meningeal sign
change in mental status
* Encephalitis ~ inflammation of the cerebral
parenchyma
fever, consciousness disturbance, seizure, focal
neurological signs
* Focal infection ~ brain abscess, subdural empyema...
Cardinal manifestations of CNS infection
• Fever
• Headache
• Seizure
• Meningeal signs (neck stiffness, Brudzinski/Kernig’s sign)
(B – brain, K – knee)
• May absent in infant < 6m/o and in elderly
• IICP signs ~ headache, projectile vomiting, papilledema
Cushing triad:
hypertension, bradycardia, irregular respiration pattern
• Focal signs or mental status change
• Course:
• Acute: viral or bacterial
• Subacute: TB or Cryptococcal
Pathogenesis
Hematogenous
From septicemia, infection of lung, heart
(endocartditis), or other viscera
Direct extension
From skull, spine, sinusitis, otitis, osteomyelitis,
and brain abscess
Risk factors
DM, alcoholism, liver cirrhosis, head trauma or
operation (otological or neurosurgical )
Diagnosis - CSF and Lumbar Puncture
• CSF
• Production : 60% from choroid plexus
• Total volume: 140ml in adult
• Production rate in adult: 500-600ml/day
• Function
• Normal composition ~
-- Cells: mononuclear cells < 5/ul (lymphocyte predominant)
-- RBCs: indicate SAH
-- Glucose: 50-75 mg/dl (1/2 ~ 2/3 of blood glucose)
-- Total protein: 15-50 mg/dl
-- Pressure: 80-180mmCSF
Contraindication of lumbar puncture
Acute
bacterial ↑ > 100 WBC, PMN
predominant
60-1000 5-40, in most
case (absence of
hyperglycemia ),
or <20%,
elevated lactate
50 – 500, lymphocyte
Tuberculous
↑ predominant except in
Nearly
always
Usually reduced,
<45 in 75% of
early stages when PMN elevated, cases (<50%)
may >80% usually 60-
700
Cryptococcal
↑ 30-300, average 50,
lymphocyte predominant
Usually
100-700
Reduced in most
cases, average
average 30 (<50%)
100
CSF in meningitis (2)
Meningitis Pressure WBC Protein Glucose