Intracranial Pressure Management

Questions and Answers

What is a significant finding in the CSF of individuals with tuberculous meningitis compared to those with other types of meningitis?

No change in adenosine deaminase (ADA) activity

Decreased adenosine deaminase (ADA) activity

Increased adenosine deaminase (ADA) activity (correct)

Fluctuating adenosine deaminase (ADA) activity

Which of the following factors can confound the reported sensitivity and specificity of ADA activity in diagnosing tuberculous meningitis?

Type of CSF collection method used

Age of the patient at diagnosis

Gender of the patient

Comorbidities, especially HIV (correct)

What adjunctive treatment is commonly given for tuberculous meningitis?

Glucocorticoids such as dexamethasone (correct)

Antiretroviral therapy

Antifungal medication

Broad-spectrum antibiotics

Which imaging findings are associated with tuberculous meningitis?

Hydrocephalus and basilar meningeal thickening Signup and view all the answers

What clinical signs may suggest meningoencephalitis in a child with tuberculous meningitis?

Overextended head position and neck stiffness Signup and view all the answers

What is the physiological intracranial pressure (ICP) for adults in the supine position?

15 mm Hg Signup and view all the answers

Which symptom is more commonly associated with viral meningitis?

Myalgia Signup and view all the answers

Which of the following symptoms can indicate elevated ICP?

Impaired consciousness Signup and view all the answers

What is a classic sign of meningeal irritation?

Kernig sign Signup and view all the answers

What does a sustained ICP of ≥ 20 mm Hg typically indicate?

Intracranial hypertension Signup and view all the answers

Which type of therapy is commonly used for managing refractory intracranial hypertension?

Barbiturate coma Signup and view all the answers

Which of the following is a hallmark feature of meningoencephalitis?

Signs of brain parenchyma inflammation Signup and view all the answers

What is a common non-surgical management strategy for elevated ICP?

Positioning and sedation Signup and view all the answers

Which condition is less likely to present with the classic triad of meningitis features in neonates?

Viral meningitis Signup and view all the answers

Which of the following conditions can lead to elevated ICP?

Neurological tumors Signup and view all the answers

What systemic sign is commonly associated with acute inflammation in meningitis?

Tachycardia Signup and view all the answers

What is ICP monitoring essential for?

Quantifying intracranial pressure Signup and view all the answers

What characteristic rash is suggestive of meningococcemia?

Petechiae Signup and view all the answers

What symptom indicates increased intracranial pressure in meningitis patients?

Papilledema Signup and view all the answers

In cases of elevated ICP, which medical therapy would NOT typically be used?

Oral antibiotics Signup and view all the answers

Which feature is more commonly observed in adults with meningococcemia?

Waterhouse-Friderichsen syndrome Signup and view all the answers

What is the primary indication for administering corticosteroids in bacterial meningitis?

To reduce systemic inflammation in cases of S.pneumoniae or H.influenzae Signup and view all the answers

What is the recommended agent for the treatment of suspected or proven meningitis due to S.pneumoniae or H.influenzae?

Dexamethasone Signup and view all the answers

What should be done if a pathogen other than S.pneumoniae or H.influenzae is identified after the administration of dexamethasone?

Discontinue dexamethasone treatment Signup and view all the answers

Which is the incubation period for Tuberculous meningitis caused by Mycobacterium tuberculosis?

2–8 weeks Signup and view all the answers

Which clinical feature is most commonly associated with basal meningitis due to Tuberculous meningitis?

Focal neurological deficits Signup and view all the answers

What is considered the gold standard for diagnosing Tuberculous meningitis?

CSF culture results Signup and view all the answers

What is a potential side effect of corticosteroid treatment in meningitis?

Hyperglycaemia Signup and view all the answers

When should antibiotics be administered concerning corticosteroid treatment in meningitis?

Before or concurrently with dexamethasone Signup and view all the answers

What is the prognosis for untreated bacterial meningitis?

It is fatal if left untreated. Signup and view all the answers

Which of the following is true regarding viral meningitis?

Most cases resolve spontaneously. Signup and view all the answers

What is a significant risk associated with fungal meningitis?

It has a high mortality rate and can cause neurological sequelae. Signup and view all the answers

What is the primary method of preventing meningitis caused by infections that spread to the CNS?

Prompt treatment of other infections such as mastoiditis. Signup and view all the answers

What is recommended for close contacts of an index patient with bacterial meningitis?

They should receive immediate postexposure chemoprophylaxis. Signup and view all the answers

Which of the following treatments should be avoided for pregnant patients exposed to bacterial meningitis?

Ciprofloxacin Signup and view all the answers

What factor significantly influences the prognosis of treated bacterial meningitis?

The patient's age and immune status. Signup and view all the answers

Which of the following is recommended as a postexposure regimen for bacterial meningitis?

Rifampin or ceftriaxone depending on the situation. Signup and view all the answers

Study Notes

Hemodynamic Support and Management

Provide hemodynamic support through the administration of fluids or vasopressors.
Identify and reverse coagulopathies to stabilize patient condition.
Evaluate and treat elevated intracranial pressure (ICP).

Intracranial Pressure (ICP)

ICP is the pressure within the cranium, influenced by positioning and physiological factors like cardiac contractions.
Normal ICP in supine adults is ≤ 15 mm Hg; an ICP of ≥ 20 mm Hg indicates pathological intracranial hypertension.
Elevated ICP can decrease cerebral perfusion pressure and lead to brain herniation.
Nonspecific symptoms of elevated ICP include impaired consciousness, headache, and vomiting.
Specific indications of ICP elevation include findings from brain imaging (e.g., midline shift) and physical exam (e.g., papilledema).

Management of Elevated ICP

Expedient surgical intervention for drainable or resectable lesions is essential.
Conservative measures include positioning, sedation, and the use of antipyretics.
Employ medical therapies such as hyperosmolar agents (mannitol or hypertonic saline) and glucocorticoids.
Refractory intracranial hypertension may require CSF drainage, hyperventilation, or decompressive craniectomy.

Meningitis: Causes and Symptoms

Meningococcemia symptoms include myalgia, petechial or purpuric rash, and possibly Waterhouse-Friderichsen syndrome.
Viral meningitis often presents with flu-like symptoms, low-grade fever, malaise, myalgia, and upper respiratory symptoms.
Less than half of adults exhibit all classic meningitis triad symptoms; neonates typically show nonspecific signs.

Clinical Features

Signs of meningeal irritation: neck stiffness, Kernig sign, and Brudzinski sign.
Systemic signs of inflammation may include fever, hypotension, and tachycardia.
Symptoms indicative of increased ICP include cranial nerve palsies and papilledema.

Diagnosing Meningitis Types

Classic triad of meningitis may also present in subarachnoid hemorrhage with a sudden onset.
Physical examination can reveal signs of underlying infections (e.g., acute otitis media or specific rashes).

Meningoencephalitis Features

Meningoenecphalitis involves inflammation of both the meninges and brain parenchyma.

Treatment for Meningitis

Antibiotic regimens include cefepime for Pseudomonas aeruginosa, doxycycline for R. rickettsii, and acyclovir for herpes viruses.
Dexamethasone is indicated in proven bacterial meningitis (S. pneumoniae, H. influenzae) to reduce inflammation; it should not delay antibiotic therapy.
Tuberculous meningitis connected to Mycobacterium tuberculosis appears after a 2-8 week incubation with subacute presentation.

Tuberculous Meningitis: Clinical Features

Typical meningitis symptoms with focal neurological deficits and prolonged clinical course.
CSF analysis reveals acid-fast bacilli, and adenosine deaminase activity is significantly elevated.

Prognosis and Complications

Untreated bacterial meningitis is often fatal; prognosis in treated cases depends on various patient factors.
Viral meningitis usually resolves spontaneously, but complications like hearing loss are rare.
Fungal meningitis has a higher mortality rate and neurological complications; adherence to treatment is crucial.

Prevention Strategies

Primary prevention involves treating infections that could spread to the CNS and vaccination against meningococcal disease.
Postexposure chemoprophylaxis should be administered swiftly to close contacts to limit transmission, with specific regimens identified for various pathogens.

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Description

This quiz covers the assessment and management of intracranial pressure (ICP) in adult patients. It includes information on providing hemodynamic support, identifying coagulopathy, and treating elevated ICP. Test your knowledge on the necessary medical interventions and physiological considerations involved in managing ICP.