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Chapter 64 Management of Patients with
Neurologic Infections,
Autoimmune Disorders, and Neuropathies
Meningitis
• Inflammation of the meninges in spinal cord/brain Viral → Most common form of meningitis
(aseptic)
• Bacterial → Streptococcus pneumoniae and Neisseria meningitidis cause majority of adult
infections →acquired in large shared communal spaces, most deadly (septic)
• Fungal → Cryptococcal meningitis most common fungal seen in patients with AIDS o Patho:
The bloodstream because of other infections
o Direct spread (ex. Traumatic injury to the facial bones or secondary to invasive
procedures)
Prevention
• Vaccination for meningococcal between 11- 12 years of age and booster at 16 years of age
• Military and first year college students are most at risk if not vaccinated
• People exposed need to be treated with rifampin (Rifadin), ciprofloxacin hydrochloride
( Cipro), or ceftriaxone sodium (Rocephin )
Clinical Manifestations
• Headache that does not go away, nothing
relives it
• Possible altered LOC
• Fever
• Meningeal irritation (elicits pain) o Neck
immobility→ nuchal rigidity o Positive Kernig
sign
o Positive Brudzinski sign (lifting head raises legs)
o Photophobia
o Rash can be striking from bacterial infection
• Early – disorientation, memory impairment, behavioral changes
• Progression - lethargy, unresponsiveness, and coma may develop
• Seizures can occur with irritability to the brain, ICP can also increase secondary to
hydrocephalus.
Diagnostic
• CT done to detect any shifting of brain contents before LP done if altered LOC, papilledema,
neurologic deficits, new onset seizure
• Lumbar puncture w/ CSF analysis → most diagnostic o Cloudy → Increased WBC & protein,
Decreased glucose, Elevated CSF pressure
• Bacterial: increased leukocytes, neutrophils, protein
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• Viral: leukocytes, protein, glucose
• Blood culture and Gram staining
• CSF culture and Gram staining
• Table 69-1 CSF values diagnostic for meningitis
Prevention
● Recommendation that the meningococcal conjugated vaccine be given to youth at 11 to 12
years of age, with a booster dose at 16 years of age. First-year college students and members
of the military who have not been vaccinated are at higher risk
● People in close contact with patients with meningococcal meningitis should be treated with
antimicrobial chemoprophylaxis using
Rifampin (Rifadin), ciprofloxacin hydrochloride (Cipro), or ceftriaxone sodium (Rocephin).
● Therapy should be started within 24 hours after exposure because a delay limits the
effectiveness of the prophylaxis.
● Vaccination should also be considered as an adjunct to antibiotic chemoprophylaxis for
anyone living with a person who develops meningococcal infection.
● Vaccination against Haemophilus influenzae and S. Pneumoniae should be encouraged for
children and adults who are at-risk
Management
• IV antibiotic therapy, if bacterial, Penicillin G combo with cephalosporins
• Dexamethasone → steroid to ↓ edema/swelling (watch blood sugar)
• Volume if dehydrated → give fluid
• Control and management of seizures → at risk, on seizure precautions
• Control fever
• Monitor vital signs and neurological status (keeping environment quiet and calm, cluster care)
• Pain management → HA
• Infection control precautions until on antibiotic therapy for 24 hours
• Isolation → Droplet for at least 24 hours
• Monitor for possible complications such as SIADH r/t inflammation
• Monitor neurologic changes, VS assess for shock
Check your understanding
A nurse is planning care for a client who has meningitis and is at risk for increased intracranial pressure
( ICP). Which of the following actions should the nurse plan to take? (SATA )
A. Implement seizure precautions
B. Perform neurological checks four times a day
C. Administer morphine for the report of neck and generalized pain
D. Turn off room lights and television
E. Monitor for impaired extraocular movements
F. Encourage the client to cough frequently
A, D, E
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Brain Abscess
• A collection of infectious material w/in the tissue of the
brain
• Rare occurrence mostly in immunocompromised
• Immunocompromised adults with otitis media and
rhinosinusitis are at risk
• Can result from intracranial surgery, penetrating head injury, tongue piercing
• Can cause increase in ICP; headache; vomiting; focal neurologic deficits
Assessment of Brain Abscess
• Presenting symptoms will help pinpoint location of problem
• Headache, usually worse in the morning, is the most prevalent symptom .
• Fever is present 50% of the time
Frontal lobe Temporal lobe Cerebellar abscess
• Expressive aphasia • Changes in vision • Ataxia (gait
• Frontal headaches Facial weakness disturbances)
• Hemiparesis • Localized headaches Nystagmus (vision off)
seizures Receptive aphasia • Occipital headache
•
•
•
•
Management
• History of any travel**
• MRI shows inflammation of the basal ganglia
• Igm antibodies
• EEG can identify abnormal brain waves (slowing)
• No specific medication treatment → long term IV antibiotics, CT guided aspiration (clean it out
depending on location/severity), corticosteroids
• Monitoring for seizures – safety
• Monitoring for increased ICP/ CSF evaluation
• Management of pain (headache)and fever
• Neurological assessment → stiff neck, confusion, tremors
• Large IV doses of antibiotic agents are given to penetrate the blood–brain barrier and reach the
abscess
• Antibiotics should be started ASAP; initial antibiotic started typically is ceftriaxone until culture
and sensitivity results come back
• A stereotactic CT-guided aspiration may be used to drain the abscess and identify the causative
organism
• Surgical excision is the preferred method but is not done as often as needle aspiration due to
higher risk of neurologic complications
Downloaded by NELSON KIIRU ()
Chapter 64 Management of Patients with
Neurologic Infections,
Autoimmune Disorders, and Neuropathies
Meningitis
• Inflammation of the meninges in spinal cord/brain Viral → Most common form of meningitis
(aseptic)
• Bacterial → Streptococcus pneumoniae and Neisseria meningitidis cause majority of adult
infections →acquired in large shared communal spaces, most deadly (septic)
• Fungal → Cryptococcal meningitis most common fungal seen in patients with AIDS o Patho:
The bloodstream because of other infections
o Direct spread (ex. Traumatic injury to the facial bones or secondary to invasive
procedures)
Prevention
• Vaccination for meningococcal between 11- 12 years of age and booster at 16 years of age
• Military and first year college students are most at risk if not vaccinated
• People exposed need to be treated with rifampin (Rifadin), ciprofloxacin hydrochloride
( Cipro), or ceftriaxone sodium (Rocephin )
Clinical Manifestations
• Headache that does not go away, nothing
relives it
• Possible altered LOC
• Fever
• Meningeal irritation (elicits pain) o Neck
immobility→ nuchal rigidity o Positive Kernig
sign
o Positive Brudzinski sign (lifting head raises legs)
o Photophobia
o Rash can be striking from bacterial infection
• Early – disorientation, memory impairment, behavioral changes
• Progression - lethargy, unresponsiveness, and coma may develop
• Seizures can occur with irritability to the brain, ICP can also increase secondary to
hydrocephalus.
Diagnostic
• CT done to detect any shifting of brain contents before LP done if altered LOC, papilledema,
neurologic deficits, new onset seizure
• Lumbar puncture w/ CSF analysis → most diagnostic o Cloudy → Increased WBC & protein,
Decreased glucose, Elevated CSF pressure
• Bacterial: increased leukocytes, neutrophils, protein
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
• Viral: leukocytes, protein, glucose
• Blood culture and Gram staining
• CSF culture and Gram staining
• Table 69-1 CSF values diagnostic for meningitis
Prevention
● Recommendation that the meningococcal conjugated vaccine be given to youth at 11 to 12
years of age, with a booster dose at 16 years of age. First-year college students and members
of the military who have not been vaccinated are at higher risk
● People in close contact with patients with meningococcal meningitis should be treated with
antimicrobial chemoprophylaxis using
Rifampin (Rifadin), ciprofloxacin hydrochloride (Cipro), or ceftriaxone sodium (Rocephin).
● Therapy should be started within 24 hours after exposure because a delay limits the
effectiveness of the prophylaxis.
● Vaccination should also be considered as an adjunct to antibiotic chemoprophylaxis for
anyone living with a person who develops meningococcal infection.
● Vaccination against Haemophilus influenzae and S. Pneumoniae should be encouraged for
children and adults who are at-risk
Management
• IV antibiotic therapy, if bacterial, Penicillin G combo with cephalosporins
• Dexamethasone → steroid to ↓ edema/swelling (watch blood sugar)
• Volume if dehydrated → give fluid
• Control and management of seizures → at risk, on seizure precautions
• Control fever
• Monitor vital signs and neurological status (keeping environment quiet and calm, cluster care)
• Pain management → HA
• Infection control precautions until on antibiotic therapy for 24 hours
• Isolation → Droplet for at least 24 hours
• Monitor for possible complications such as SIADH r/t inflammation
• Monitor neurologic changes, VS assess for shock
Check your understanding
A nurse is planning care for a client who has meningitis and is at risk for increased intracranial pressure
( ICP). Which of the following actions should the nurse plan to take? (SATA )
A. Implement seizure precautions
B. Perform neurological checks four times a day
C. Administer morphine for the report of neck and generalized pain
D. Turn off room lights and television
E. Monitor for impaired extraocular movements
F. Encourage the client to cough frequently
A, D, E
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
Brain Abscess
• A collection of infectious material w/in the tissue of the
brain
• Rare occurrence mostly in immunocompromised
• Immunocompromised adults with otitis media and
rhinosinusitis are at risk
• Can result from intracranial surgery, penetrating head injury, tongue piercing
• Can cause increase in ICP; headache; vomiting; focal neurologic deficits
Assessment of Brain Abscess
• Presenting symptoms will help pinpoint location of problem
• Headache, usually worse in the morning, is the most prevalent symptom .
• Fever is present 50% of the time
Frontal lobe Temporal lobe Cerebellar abscess
• Expressive aphasia • Changes in vision • Ataxia (gait
• Frontal headaches Facial weakness disturbances)
• Hemiparesis • Localized headaches Nystagmus (vision off)
seizures Receptive aphasia • Occipital headache
•
•
•
•
Management
• History of any travel**
• MRI shows inflammation of the basal ganglia
• Igm antibodies
• EEG can identify abnormal brain waves (slowing)
• No specific medication treatment → long term IV antibiotics, CT guided aspiration (clean it out
depending on location/severity), corticosteroids
• Monitoring for seizures – safety
• Monitoring for increased ICP/ CSF evaluation
• Management of pain (headache)and fever
• Neurological assessment → stiff neck, confusion, tremors
• Large IV doses of antibiotic agents are given to penetrate the blood–brain barrier and reach the
abscess
• Antibiotics should be started ASAP; initial antibiotic started typically is ceftriaxone until culture
and sensitivity results come back
• A stereotactic CT-guided aspiration may be used to drain the abscess and identify the causative
organism
• Surgical excision is the preferred method but is not done as often as needle aspiration due to
higher risk of neurologic complications
Downloaded by NELSON KIIRU ()
