# Meningitis --- **Meningitis** is an inflammation of the [[meninges]], or the protective structures surrounding the brain and spinal cord. It is a relatively rare condition, but it is quite serious due to the increase in [[intercranial pressure]] that it causes. It is most commonly bacterial in origin (80% of cases) but it can also be viral or even fungal. It can also occur secondary to lymphoma or leukemia. Although meningitis is treatable, the risks of an unfavorable go up in certain cases, such as: - delayed treatement - older age - heart rate >120 - low [[Glasgow coma score]] - cranial nerve palsies - positive gram stain within 1 hour of getting to the hospital - indicates a strong infection The bacteria that tend to cause meningitis are: - *[[Streptococcus|Streptococcus pneumoniae]]* - *Neisseria meningitides* - this is especially common in dense community groups such as college dorms or army barracks - *[[Haemophilus influenzae]]* - protection against this in the form of the Hib vaccine for infants and children ![[meningitis.png]] ## Risk Factors Risk factors for contracting bacterial meningitis are: - being unvaccinated - particularly first-year college students and people in the military - tobacco use - viral upper respiratory infection/[[otitis media]]/mastoiditis - damage to the ears, nose or throat can make it easier for bacteria to travel to the brain/spinal cord - immune system deficiencies ## Signs & Symptoms The signs and symptoms of meningitis - headache with fever and chills - usually very severe and either steady or throbbing - altered mental status - neurologic deficits - confusion - seizures - weakness/paralysis - difficulty speaking/understanding speech - memory loss - neck immobility, or "nuchal rigidity" - photophobia - a specific type of **rash** "meningococcal meningitidis" - occurs in about half of patients with meningococcal meningitis - seen as a "pin prick" rash in infants - Kernig's sign - When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended - Brudzinski's sign - When the patient’s neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity - More sensitive than Kernig's sign ![[kernig and brudzinski signs.png]] ## Diagnostic Tests - CT or MRI - you want to make sure you *do this before* a lumbar puncture to makes sure there is a normal [[intercranial pressure|ICP]], otherwise this can lead to a brain herniation. - [[lumbar puncture]] ## Treatment The best treatment of meningitis is preventing it from happening in the first place, such as getting the [[Haemophilus influenzae|Hib vaccine]] and following good infection prevention measures like handwashing. If meningitis does occur, the earlier the administration of [[antibiotics]] the better. (Of course, these antibiotics must be able to cross the [[blood-brain barrier]]!) Meds: - Antibiotics will probably be penicillin G with one of the cephalosporins - The sooner the better! Within 30 minutes of arrival at the hospital if possible. - [[steroidal anti-inflammatory]] like **dexamethasone** for the inflammation - [[analgesic|analgesics]] for the pain ## Nursing Considerations - Frequent neuro checks and vitals - be on the lookout for respiratory complications - watch for signs of increased [[intercranial pressure]] - can possibly cause [[SIADH]] - encourage dark, quite environment with a **lot of rest** - this is one of the few times we're not getting patients up to mobilize as much as we can ___