Shouriks SPOOKY

Second SDL

By Shourik Dutta
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A 19-year-old woman presented to the emergency department with confusion,
lethargy, and neck stiffness. Her dorm mates reported that she had experienced
upper respiratory symptoms for 3 or 4 days before presentation. She had no
significant past medical history. On physical examination, her temperature was 37 C
(98.6 F), her pulse was 100 beats/min, respirations were 20/min, and her blood
pressure was 110/70 mm Hg. The pharynx was slightly injected without exudate.
Heart and lung examination results were normal. No rash was present. Neurologic
examination revealed a slightly obtund, sleepy woman with otherwise intact mental
status, intact cranial nerves, no motor or sensory deficits, and normal reflexes.
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However, she was admitted for observation. Very soon thereafter, she complained of
increasingly severe headache and neck pain. On exam, she was definitely confused
and now had a fever of 39.1 C (102.4 F). Physical exam had 2 findings. While laid
supine with hips and legs flexed, patient complained of severe pain with extension of
leg beyond 135 degrees. Additionally, patient showed hip and leg flexion when a
nurse attempted to move her neck forward while keeping a hand on her chest to keep
her back on the exam table. Lumbar puncture demonstrated a cloudy CSF with 670
WBCs (90% PMNs), a glucose level of 1 mg/dL, and a protein level of 220 mg/ dL.
WHAT COULD SHE POSSIBLY HAVE? CAN YOU SAVE HER?
Diagnosis

Do you want a hint?

Diagnosis

Its meningitis.

But what kind?!!!

Diagnosis

What causes it

A) Viral meningitis

B) Neisseria meningitidis

C) Streptococcal pneumoniae
Diagnosis

What causes it

A) Viral meningitis

B) Neisseria meningitidis

C) Streptococcal pneumoniae
Meningitis - Background
Acute inflammation of
meninges

Cause = an array of both

bacterial or viral microbes

Medical emergency

Differential by age
Microbial Origins
Bacterial

Group B streptococci

Neisseria meningitidis -> meningococcus

Streptococcus pneumoniae

Viral

Enteroviruses -> RNA viruses -> small intestine

HIV

Herpes
Age Based Causes
 Differential Symptoms

- Adults (streptococcus - Infants (Group B

Shouriks high yield
pneumoniae) streptococcus)
note of the day:
Neisseria
- Nuchal rigidity - NO STIFF NECK YOOOO
meningitidis aka
meningococcal ->
- Headache - Nonspecific symptoms
petechial
rash/purpura
- Fever - Fever

- Coma - Vomiting

- Altered consciousness - Poor feeding

- photosensitivity - irritability
Diagnosis

1. Lumbar Puncture -> run labs on

CSF

a. May need CT if tumor or high ICP

2. Blood Test

3. Kernig Sign

4. Brudzinski Sign
Treatment

Delay = poorer outcomes -> move fast

Prevention is the best cure -> vaccines (PCV)

Empiric Antibiotics

If bacterial..

Cefalosporin + vancomycin (both beta lactams -> break down

peptidoglycan wall)

Chloramphenicol (TBT TO FOM WHEN WE LEARNED THAT THIS

INHIBITS PEPTIDE BOND FORMATION IN BACTERIAL PROTEIN
SyNTH)+ ampicillin
Preguntas?