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    Meningitis PLUS: Goetz: Textbook of Clinical Neurology, 1st Ed

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    introvoyz041
    The document summarizes key points about meningitis. It discusses that the differential diagnosis for low CSF glucose includes infectious causes like bacterial meningitis, tuberculosis, and fungal meningitis as well as inflammatory conditions like sarcoidosis and carcinomatous meningitis. Very high CSF protein levels over 500 mg/dL can be seen in bacterial meningitis, subarachnoid hemorrhage, or spinal block. The typical CSF pattern in acute neurosyphilis includes elevated opening pressure, lymphocytic pleocytosis, elevated protein, and possibly low glucose with a positive CSF-VDRL test.

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    Meningitis PLUS: Goetz: Textbook of Clinical Neurology, 1st Ed

    Uploaded by

    introvoyz041
    33 views1 page
    The document summarizes key points about meningitis. It discusses that the differential diagnosis for low CSF glucose includes infectious causes like bacterial meningitis, tuberculosis, and fungal meningitis as well as inflammatory conditions like sarcoidosis and carcinomatous meningitis. Very high CSF protein levels over 500 mg/dL can be seen in bacterial meningitis, subarachnoid hemorrhage, or spinal block. The typical CSF pattern in acute neurosyphilis includes elevated opening pressure, lymphocytic pleocytosis, elevated protein, and possibly low glucose with a positive CSF-VDRL test.

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    Meningitis Plus

    Original Title

    Meningits PLUS

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    The document summarizes key points about meningitis. It discusses that the differential diagnosis for low CSF glucose includes infectious causes like bacterial meningitis, tuberculosis, and fungal meningitis as well as inflammatory conditions like sarcoidosis and carcinomatous meningitis. Very high CSF protein levels over 500 mg/dL can be seen in bacterial meningitis, subarachnoid hemorrhage, or spinal block. The typical CSF pattern in acute neurosyphilis includes elevated opening pressure, lymphocytic pleocytosis, elevated protein, and possibly low glucose with a positive CSF-VDRL test.

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    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views1 page

    Meningitis PLUS: Goetz: Textbook of Clinical Neurology, 1st Ed

    Uploaded by

    introvoyz041
    The document summarizes key points about meningitis. It discusses that the differential diagnosis for low CSF glucose includes infectious causes like bacterial meningitis, tuberculosis, and fungal meningitis as well as inflammatory conditions like sarcoidosis and carcinomatous meningitis. Very high CSF protein levels over 500 mg/dL can be seen in bacterial meningitis, subarachnoid hemorrhage, or spinal block. The typical CSF pattern in acute neurosyphilis includes elevated opening pressure, lymphocytic pleocytosis, elevated protein, and possibly low glucose with a positive CSF-VDRL test.

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    © All Rights Reserved
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    of 1

    BAS/CSC 7/25/02

    Meningitis PLUS
    Key Points:
    The differential diagnosis for hypoglycorrhachia (low CSF glucose) is infectious (bacteria, TB,
    fungal), sarcoid, carcinomatous meningitis.
    The causes of extremely elevated CSF protein (> 500 mg/dL) are bacterial meningitis, SAH, and
    spinal block.
    The typical CSF pattern in acute neurosyphilis is elevated OP, lymphocytic pleocytosis, elevated
    protein, +/- low glucose, positive CSF-VDRL.

    1.

    What is the differential diagnosis for hypoglycorrhachia (low CSF glucose)?


    Infections: bacterial meningitis, TB, fungal, parasitic (cysticercosis, amoeba), rare viral
    Inflammatory: sarcoid
    Cancer: carcinomatous meningitis

    2.

    What are the typical CSF findings in carcinomatous meningitis?


    Elevated opening pressure, hypoglycorrhachia, elevated protein
    Pleocytosis, lymphocytic or polys

    3.

    What are the causes of very elevated CSF protein (> 500 mg/dL)?
    Bacterial Meningitis
    Subarachnoid hemorrhage (protein increases 1 mg/dL / 1000 RBCs)
    Spinal block (inflammatory, infectious, malignant)
    Froins syndrome: spontaneous coagulation of CSF from elevated proteins
    secondary to spinal block

    4.

    What is a VP shunt infection?


    Epid: 2.5-15% of all shunts
    Risk factors: surgeon experience, device manipulation, duration of implant
    Micro: Coag-neg staph (30-50%), Staph aureus (30%), GNRs (including pseudomonas,
    Corynebacterium, B. cereus, Candida spp, Stenotrophomonas, etc.)
    Clinical features:
    Most infections within 1 month of surgery
    Range from no symptoms to fever to shunt fa ilure (H/A, nausea, vomiting)
    Rarely frank evidence of meningitis
    Treatment: empiric treatment with nafcillin or vanco; shunt removal is controversial

    5.

    What is the typical CSF pattern in neurosyphilis?


    The easy answer: it depends. Unfortunately, there are 6 manifestations of neurosyphilis. The
    most common we will see is probably acute syphilitic meningitis. This will present with
    meningeal signs, fever, elevated ICP (n/v, etc). Cranial nerve findings are common (CN II, VI,
    VII, and VIII). The CSF will usually show:
    Elevated opening pressure, elevated protein, +/- low glucose
    Pleocytosis, lymphocytic and probably positive CSF-VDRL

    References:
    UptoDate
    Goetz: Textbook of Clinical Neurology, 1st ed. 1999 W. B. Saunders Company, pg. 475.

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