6. • What is your diagnosis?
• How will you manage?
• What can be the complications in this
case?
7.
8. • A 23 yrs old lady is brought to ED
with c/o sudden unconsciousness.
• h/o low grade fever and mild
headache for last 1 day. No history
of vomiting or fits.
9. O/E
• A young lady lying
unconscios
• BP = 80 Systolic
pulse = 90bpm
• Temp = 100oF
• A macular purpuric
rash over legs &
abdomen
• CNS
• GCS 7/15
Plantars upgoing
• SOMI +ve
fundi
intact
19. • Same patient presents to ED after 1month
with c/o persistant vomiting. O/E
• pt is fully conscious ,oriented
• Mildly jaundiced
• Labs:
Bilirubin = 4-5 mg/dl
ALT
= 60U/L
• WHAT WILL YOU DO?
20. • Same patient comes to OPD after
3months with c/o vertgo and
instability for 3 days. Clinically there
are features of left cerebellar lesion.
• What can be the cause?
• What will be your management plan?
21. • What is your diagnosis?
• How will you manage?
23. • Same patient again brought to ED in
an unconscious state. O/E
• VITALS stable
3/15
• GCS
upgoing
• Plantars
early papilloedema
• Fundi
• CT brain Obstuctive hydrocephalus
30. • What is your diagnosis?
• How will you manage?
31.
32. • A 24 yrs old gentleman is brought to
ED with c/o high grade fever
associated with rigors & chills for
last 2 weeks, headache for 6 days
and 1 episode of GTC fits followed by
drowsiness.
33. O/E
•
•
•
•
•
A young man lying unconscious in bed.
BP
= 100/60mmHg
Pulse = 120bpm
Temp = 102oF
CNS:
GCS
5/I5
Tone decreased on right
right plantar upgoing
fundi bilateral papilloedema
36. • What is your diagnosis?
• How will you manage?
37.
38. A young boy of age 20 is brought to
OPD with c/o low grade fever for 1
month, restlessness and depressive
mood for 1month and vomiting with
severe frontal headache for 7 days.
40. • During hospital stay, pt continued to
deteriorate. Headache & fever did
not settle despite good antibiotics &
analgesics.
• 5 days later he got rt 6th nerve palsy.
• MRI brain advised.
41. • He became incontinent.
• His mental state also deteriorated and he
became disoriented in time, place and
person.
• 5 days later he got rt 6th nerve palsy.
• No h/o fits
• MRI brain advised.
42. MRI brain
• Meningeal enhancement
• Focal tuberculomas in right frontal
and parietal region.
• So diagnosis is TBM with
tuberculomata
48. • Acute infection of meninges
• Pt presents with fever,headache, vomiting
and altered mental status.
• O/E there is neck stiffness & signs of
meningeal irritation.
• It may be bacterial, viral ,fungal, protozoal
or due to non-infective causes..
49. VIRAL MENINGITIS
• The most common cause of meningitis
• Usually benign & self-limiting
• Common viruses causing meningitis
are enteroviruses, herpes simplex,
EBV or varicella zoster.
• Mostly occurs in children & young
adults.
51. Bacterial Causes of
Meningitis
•
•
•
•
•
•
•
•
In Neonates:
E-coli
Proteus
Group B Streptococci
Listeria monocytogenes
In Pre-school Child:
H-Influenza
N-Meningitidis
Streptococcus Pneumoniae
Mycobacterium
Tuberculosis
In Older Children
and Adults:
•
•
•
•
•
•
N-Meningitidis
S Pneumoniae
Listeria
M tuberculosis
S aureus
H-Influenza
52. • Bacterial meningitis is less common
but associated with significant
morbidity & mortality.
• Most common causes are S
pneumoniae, N meningitidis and H
influenzae.
• Pt presents with fever, headache,
dowsiness & neck stiffness. Rash may
be seen in meningococcemia.
55. • It presents with acute onset of
headache, fever, focal neurological
signs and seizures.
• There may be drowsiness or coma.
• Meningism occurs in many cases.
• Most imp cause is Herpes simplex.
56. Bacteria may enter the brain via
penetrating injury. There may be
direct spread from paranasal sinuses
or middle ear. There may be
hematogenous spread from
septicemia in which case multiple
abscesses may form.
57. Clinical features
• It may present acutely with fever,
headache, meningism & drowsiness.
• Commonly it presents over days or
weeks with fever, features of raised
ICP , seizures and focal signs.
63. T/M When Cause Of
Bacterial Meningitis is Known
Pathogen
NMeningitidis
Strep
Pneumoniae
Regime of
choice
Alternative
2.4g IV
4hourlyFor 5-7
days
Ampicillin
Chloramphenicol
Benzyl Penicillin Cefuroxime
Cefotaxime
2g IV 6hourly or
Ceftriaxone
2g IV 12hourly
Chloramphenicol
65. T/M of Pyogenic Meningitis
of Unknown Cause
Pt. with typical Meningococcal Rash:
Benzyl Penicillil 2.4g IV 6 hourly.
Adults (18-50 Yr) without typical rash:
Cefotaxime 2g IV 6 hourly
or
Ceftriaxone 2g IV 12 hourly
Pt. with penicillin resistant Pneumococcal Infection:
Vancomycin 1g IV 12 hourly
or
Rifampicin 600mg IV 12 hourly
66. Pt. with suspicion of Listeria Infection:
Ampicillin
or
Co-trimoxazole
Pt. with H/O Anaphylaxis to B-Lactams:
Chloramphenicol + Vancomycin
67. T/M according to age of Pt.
Neonates and infants:
Ampicillin with Cefotaxime
Older Children and Young Adults
Penicillin G + Ceftriaxone
Older Pt. (>50 Yrs):
Ampicillin + Ceftriaxone
68. Adjuvant Therapy
1. Mannitol:
250ml IV bolus over 10-20 minutes
2. Glucocorticoids:
Dexamethasone 0.15mg/kg IV 6hourly
3. Antiepileptics:
Diazepam/Phenytoin/Barbiturates
69. Prevention Of
Meningococcal Infection
• Oral Rifampicin 600mg 12 hourly in adults
• Oral Rifampicin 5-10mg/kg 12 hourly in
children
• Ciprofloxacin 500mg in adults
(Alternative)
Vaccines:
For prevention of diseases caused by
Meningococci of Gp. A & C.
72. Brain abscess
• Antibiotics according to site of
abscess like cefuroxime &
metronidazole for frontal lobe lesion
• Anticonvulsants may be required
• Surgical treatment