• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Home
  • Notice
  • Result
    • Admission
    • BPSC
    • National University
      • Honours
      • Masters
    • PSC
    • SSC Result
    • HSC Result
  • Free Download Zone
    • Form
    • Medical Books
    • Mobile Corner
    • Freelancing
  • Medicine
    • Infectious Disease
    • Surgery
    • Orthopaedics
      • Saif Orthopaedics
    • Gynaecology
    • Easy Remember
  • Others
    • Life Style
    • Festival
  • Review

Bangladesh Result

All Result in One Place

  • About Me
  • Privacy Policy
  • Terms and Conditions
    • DMCA Policy
  • Contact
    • Ad Service
  • Sitemap
Home » Saif Orthopaedics » INFECTIONS OF CENTRAL NERVOUS SYSTEM

INFECTIONS OF CENTRAL NERVOUS SYSTEM

Table of Contents

  • INFECTIONS OF CENTRAL NERVOUS SYSTEM
    • Introduction central nervous system infection:
    • Definition of central nervous system infection:
    • Meningitis:
    • BRAIN ABSCESS  
      • Risk factors:  

INFECTIONS OF CENTRAL NERVOUS SYSTEM

Introduction central nervous system infection:

Nervous system —

  • Central Nervous System
  • Peripheral Nervous System

 

Central Nervous system –

  • Brain   — Cerebrum, Brain stem & cerebellum
  • Spinal cord

Coverings of brain – Meninges

  • Dura mater
  • Arachnoid mater
  • Pia mater

 

Definition of central nervous system infection:

Infection occurring in relation to the central nervous system.

Two types —

  • Generalized –Meningitis, Encephalitis & Myelitis
  • Localized —  Abscesses – Brain & S. Cord

 

Infections again are of two types—

  • Non-specific
  • Specific

Infection may be –

  • Bacterial
  • Viral—Herpes simplex, Herpes zoster, Jakob-Creutzfeldt disease (Mad Cow Disease)
  • Fungal –
  1. Coccidiodomycosis
  2. Blastomycosis
  3. Histplasmosis
  4. Cryptococcosis
  5. Aspergillosis
  • Parasitic-
  1. Hydatid
  2. Cesticercosis
  3. Protozoal—Malaria, Trypanosoma, Toxoplasma, E.histolytica

 

Meningitis:

meningitis
Fig: meningitis

 

Inflammation of leptomeninges.

Bacterial, Viral, Fungal.

Pyogenic, Tubercular

 

 

 

Meningitis—

  • Spontaneous -Bacteriology— Strep., Enterobactericae, Listeria

Pneumo, Meningococci, H.Influ,

Antibiotics of choice – Ampicillin, Gentamicin,

Ceftriaxone, Cefotaxime

Vancomycin, Chlorampenicol

 

  • Post-traumatic or Post-surgical (Surgical Meningitis)-

Bacteriology— Staph. aureas, Pseudomonas, Enterobactericae

Strep.

 

Antibiotics of choice – Flucoxacilline, Vancomycin, Ceftazidime

Route of entry—

  • Hematogenous
  • Direct—CSOM, Air sinus infection, Post-traumatic CSF leak, Penetrating injury,

 

Diagnosis—

  1. Clinical parameters
  2. Laboratory and imaging data

 

Length of treatment —   Antibiotics should be continued for at least 5 days after symptoms resolve.

Not less than 14 days according to some author.

 

Localized infection:

Brain abscess, Empyema, Cord abscess.

 

BRAIN ABSCESS  

brain abscess
Fig: brain abscess

 

Risk factors:  

  • Pulmonary abnormalities ( Infection, A-V fistulas)
  • Congenital cyanotic heart disease
  • Bacterial endocarditis
  • Penetrating head injury
  • CSOM
  • Sinusitis
  • AIDS

 

Source of infection:

  • Contiguous spread – CSOM, Sinusitis, Odontogenic infection.
  • Hematogenous spread – Pulmonary, Cardiac, Dental infection, GI infection, Systemic infection.

In adult- Lung abscess(most common), Bronchiectasis and Empyema.

In children- Cong. Cyanotic heart disease esp. TOF.

  • Following penetrating trauma or Neurosurgical procedures.

Site of Abscesses:

For hematogenous spread-

  • Mostly MCA territory and on the Lt. side.
  • Pulmonary origin- usually multiple, Cardiac origin- usually solitary.
  • In patients with septic embolization, risk of cerebral abscess is elevated in areas of previous infarction or ischemia.

 

For contagious spread-

  • CSOM and mastoid air cells- Temporal lobe and cerebellar abscess.
  • Nasal Sinusitis- Frontal lobe abscess.
  • Sphenoid sinusitis- Least common but high incidence of intracranial complication due to venous extension to cavernous sinus.
  • Odontogenic- Rare

 

 

Pathogens:

  • Strptococcus– most frequent, 33-50% anaerobic and microaerophilic.
  • Staph.aureas
  • Bacteroids
  • Enterobactericae
  • Fungal –  Common in transplant patients  Aspergillus fumigatus
  • Toxoplasma, Nocardia – common in immunocompromised patients.

 

 

Presentation:

  • Features of raised ICP
  • Focal neurological sign
  • Features of cause of the lesion
  • Gen. features of infection.

 

Evaluation:

Blood work

Imaging-

  • CT scan- Depends upon the stage of the disease.

Usually Iso to hypodense lesion, with contrast ring enhancement.

  • MRI – Iso to hypointense in TIWI, hyperintense on T2WI, ring enhancement in gadolinium enhancement.
  • MRS
ct scan of brain abscess
Fig: ct scan of brain abscess

 

Management:

 

Medical Treatment:

Indications:

  • If treatment can be started in cerebritic stage
  • Very small lesion < 3cm
  • Poor surgical candidate
  • Multiple small abscesses
  • Critical location- Dominant hemisphere, Brain stem
  • Concomitant Meningitis

treatment:

  • get blood culture
  • antibiotics (3rd generation cephalosporin+ metronidazole+ vancomycin) or according to blood culture
  • steroid
  • anti conversant

Surgical Treatment:

Indication:

  •  significant mass effect exerted by the lesion
  • proximity to ventricles
  • raised ICP
  • traumatic abscess with foreign body
  • multiloculated abscess

 

 

courtesy  :

Dr. Zahed, MS, FCPS

Asst. Professor, Neurology

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

Categories

  • Admission (7)
    • Medical (1)
  • Easy Remember (4)
  • Festival (8)
    • Eid (2)
  • Form (4)
  • Free Download Zone (33)
    • Medical Books (1)
    • Tips and Tricks (10)
  • Freelancing (28)
    • WordPress (3)
  • Gynaecology (16)
  • Infectious Disease (1)
  • Job (10)
  • Life Style (25)
  • Medicine (17)
  • Mobile Corner (12)
  • Notice (5)
  • Orthopaedics (3)
  • Others (15)
  • Question Solve (4)
  • Result (73)
    • Admission (9)
    • BPSC (9)
    • HSC Result (9)
    • JSC (4)
    • National University (11)
      • Degree (2)
      • Honours (4)
      • Masters (3)
    • NTRCA (2)
    • Prize Bond (2)
    • PSC (5)
    • Scholarship (1)
    • SSC Result (13)
  • Review (26)
  • Routine (8)
  • Saif Orthopaedics (14)
  • SEO (8)
  • Sports (4)
  • Surgery (4)
  • Uncategorized (3)

Recent Posts

  • Betting Site in Bangladesh – Top Sites for Satta Online
  • How to Stay Productive as a Student
  • [How To] Fix the WordPress Not Sending Emails Issue
  • Overview of the Main Benefits of Sentiment Analysis
  • 3 Resonating Content Optimization Strategies

Copyright © 2023 | Hosting Partner Boss Host BD

Go to mobile version