Aseptic meningitis—NONbacterialMost commonly viral in etiology. Associated with mumps, measles, herpes,

other viral syndromesSigns and Sx—generally gradual in onset,

but may be sudden. Headache Fever—low-grade, usually GI sx—nausea and vomiting may be R/T ICP General malaise Maculopapular rash Symptoms usually disappear in 3-10 days

Acute inflammation of meninges & CSF caused by bacterial infectionHaemophilus influenzae type B (vaccine)Streptococcus pneumoniaeNeisseria meningitidis

Risk factors: immunosuppression, preexisting CNS anomalies, chronic diseases

Organisms may come from infections in teeth, sinuses, tonsils, lungs, skull fracture

Etiology by age of incidence:Neonate-3 months: Group B Beta Strep

and E.Coli

3 months-3 years: Haemophilus Influenzae Type B Streptococcus pneumonieae Neisseria meningitidis (meningococcal) Staphylococcus aureus

School-age and beyond: Meningococcal due to high transmissibility through droplet form.

Hx of URI or ear infection Irritabilitiy, restlessness Severe HA, fever, chills, vomiting Stiff neck (nuchal rigidity) can

progress to point of opisthotonos Alterations in sensorium High pitched cry in infants; bulging

fontanel May begin w/seizure or develop later Photophobia Kernig’s and Brudzinski’s sign

Dx: Hx/physical and lumbar puncture CSF cloudy; culture done **KNOW CSF FLUID

RESULTS!! Management:

Begin IV antibiotics and fluids IMMEDIATELY Respiratory isolation till on meds for 24hrs if

bacterial, longer if viral NPO Freq VS & neuro checks I&O Assess for ↑ICP; Keep HOB elevated Assess for SIADH – may need to restrict fluids Keep room/environment quiet, darkened; ↓stimuli Pain meds as ordered; uninterrupted rest periods Seizure precautions Reportable to local Health Dept.

Complications of meningitis: epilepsyneuro damage (brain damage to learning

disabilities) hearing or vision loss – hearing most

commonhydrocephalus10-15% mortality

Acute toxic encephalopathy w/other organ involvement; fatty changes in liver

Sudden change in LOC, fever, vomiting Progresses rapidly; ↑ICP; death Risk factors: triggered by a mild viral

illness like chickenpox or flu and use of salicylates especially Aspirin

Children <18; most bet 4 – 14 yrs Liver Bx is final clinical Dx

Quiet, lethargic, vomiting Confusion, combativeness, hyper-

reflexia Obtunded, seizures, decorticate rigidity Deepening coma, fixed pupils Coma, loss of deep tenden reflexes,

flaccid,respiratory arrest

ICU – monitor for cerebral edema; ICP Assess resp status, CVP, arterial pressure Oxygen; intubation if needed Accurate and frequent I & O Tx: shock (fluids, electrolytes,

vasopressors) Tx: for ↑ICP –keep ↑HOB, airway support,

administer mannitol as ordered) Treat hyperthermia(cooling & meds) Supportive care & ongoing info for family

Malfunction in the electrical system of the brain; alterations in the firing of the neurons by group of hyper-excitable cells

Epilepsy: chronic DO w/recurrent seizures Partial – begins local in one hemisphere

Simple partial or partial complex Generalized – both hemispheres

Immed loss of consciousnessTonic clonic and petit mal

Simple partial: No loss of consciousness; alterations in motor function, autonomic signs, sensory symptoms

Partial complex: consciousness impaired; staring, lip smacking, chewing, unusual hand movements

Petit mal or Absence: lack of awareness, unresponsive; lasts less than 15 secs; abrupt onset and cessation

Tonic clonic: Aura does NOT precede seizure. Postictal period after seizure: relaxation, confusion, amnesia, unresponsivenessTonic: sudden loss of consciousness, cry

out & muscles get rigid; jaw clenchedClonic: alternate contraction and

relaxation of extremities

Prolonged seizures: > 20 min or recurrent

OR postictal period > 30 min Medical emergency → resp failure,

hypotension, hypoxic brain damage, hypoglycemia

ICU – need IV benzodiazepineDiazepam or Lorazepam If IV access is difficult, EBP has shown that

anti-convulsants administered rectally via a 5-8 French feeding tube with syringe is very effective.

When to call 911 If no history of previous seizureNot breathingSeizure lasting > 5minutes

Turn child to side; put NOTHING in mouth

Do not restrict movement Protect head – maintain safe

environment Observe, record, and report seizure

activity Provide information/teaching to family

Anticonvulsants:Phenobarbital Phenytoin (Dilantin): gum hyperplasia SECarbamazepine (Tegretol)Valproic acid (Depakene)Primidone (Mysoline)Ethosuximide (Zarontin)Clonazepam (Klonopin)