Acute Bacterial Meningitis: Predisposing Factor Head Trauma

by Carlo Raj, MD

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    00:00 Here’s another table with acute bacterial meningitis, but this time, we’re dealing with trauma.

    00:07 In the previous table, we looked at common causes of acute meningitis, primarily bacterial And the parameter that we used there was age groups.

    00:16 And we began with very young and very old, two extremes.

    00:21 And then you had everything in the middle.

    00:22 Remember with the age between, let’s say 2 and 50 years of age, we’re looking at organisms such as neisseria meningitidis and maybe Streptococcus pneumoniae Now, in this table, what we’re paying attention to is, well, what if there is an external type of damage taking place to the skull? So as opposed to age groups, let’s say that there was a basilar skull fracture, and what kind of common bacterial pathogens could be seen.

    00:49 Now, once again, Haemophilus influenzae.

    00:52 For convenience sake, I have grouped everything together here, please forgive me.

    00:57 Now, here vancomycin and plus your third generation cephalosporin is what you’re thinking.

    01:03 If there’s a penetrating trauma, what kind of organisms are going to make it into the brain or into the cavity.

    01:13 Well, here, it could be Staph aureus or coagulase-negative such as your Staphylococcus epidermidis.

    01:21 We could have aerobic gram-negative bacilli, including pseudomonas.

    01:25 And here we have once again, common denominator, would be your vancomycin and we have different types of our cefepime, our ceftazidime and so on and so forth.

    01:38 Common denominator, vancomycin There overall, what we’re looking at here is meningitis, within age groups and trauma and common organism that would then be expected to be seen.

    01:53 Predisposing factor, continuing on this table here, is if the patient was post neurosurgery.

    01:59 And here, you should be thinking about aerobic gram-negative bacilli, and here once again, it will be something like your pseudomonas.

    02:07 And we have coagulase-negative such as our epidermidis.

    02:12 Post-surgery, what happened? Patient unfortunately starts developing symptoms of meningitis.

    02:18 Vancomycin, common denominator.

    02:21 What if there was a shunt? So what if a shunt is required? Remember, whenever there is a shunt that is required in your patient, there’s every possibility that you have organisms that has gained access.

    02:34 So here, once again, we have your coagulase negative Staphylococcus epidermidis and others including our Pseudomonas.

    02:42 The other one that you’ll find to be quite interesting as well with the CSF shunt is think about-- Look at these organisms.

    02:50 A lot of these organisms are coming from looks like your flora of the skin including your Propionibacterium acnes.

    02:58 Isn’t that interesting? And vancomycin.

    03:01 So overall, understand the concept.

    03:04 And once you do, then you plug in the details as to what are the organisms that are gaining access to the cranial cavity? In summary, risk factors, well, actually a bunch of them.

    03:19 Age groups, obviously.

    03:21 We have trauma, post neurosurgery, or maybe CSF shunts.

    03:25 Preventative medicine for the most part, common denominator would be vancomycin.

    03:30 Signs and symptoms as you can expect from meningitis: nuchal rigidity, headache, photophobia.

    03:36 Differential diagnosis: Just to keep this in mind, sinusitis or abscesses.

    03:42 But the presentation will be quite different.

    03:43 Diagnostic workup: Head CT and blood cultures and, of course, lumbar puncture, we’d spent extensive time on a table with lumbar puncture.

    03:52 Treatment: Obviously, antibiotics of various sorts.

    About the Lecture

    The lecture Acute Bacterial Meningitis: Predisposing Factor Head Trauma by Carlo Raj, MD is from the course CNS Infection—Clinical Neurology. It contains the following chapters:

    • Acute Bacterial Meningitis: Factor - Head trauma
    • Bacterial Meningitis: Summary

    Included Quiz Questions

    1. Basillar skull fracture
    2. Penetrating trauma to the head
    3. Post neurosurgery
    4. CSF shunt
    5. Purulent meningitis caused by streptococcal pneumonia in a 1-year-old.
    1. Propionibacterium acnes
    2. Hemophilus influenzae
    3. Group A beta hemolytic streptococci
    4. Streptococcus pneumonia
    5. Neisseria meningitidis
    1. Sulphonamides
    2. Vancomycin
    3. Cefepime
    4. Ceftazidime
    5. Meropenem

    Author of lecture Acute Bacterial Meningitis: Predisposing Factor Head Trauma

     Carlo Raj, MD

    Carlo Raj, MD

    Customer reviews

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    Minor mistake but excellent nonetheless
    By Glen K. on 22. February 2018 for Acute Bacterial Meningitis: Predisposing Factor Head Trauma

    Despite that Dr. Raj inaccurately recognized H. influenzae as a virus (which is actually a G(-) bacterium), he did a good job of engaging students in thinking and reflecting, while pointing out a general memory-aiding scheme ( e.g. common skin flora species being implicated in post-neurosurgery/penetrating trauma/CSF-associated meningitides) Having watched many of Dr Raj's videos (a med-student with high standards myself and always hateful of lackadaisical teaching styles of the MAJORITY of professors in my country), I have to say Dr. Raj exhibits excellent "mentor" qualities in a style of his own.

    A very bad lecture
    By Avinoam M. on 08. May 2017 for Acute Bacterial Meningitis: Predisposing Factor Head Trauma

    A very bad lecture. Mistakes that can not be said lecture after lecture