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  #1  
Old 08-17-2011
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Neuro Seizures and Papilledema, what to do?

A 13-year-old pre-med bound girl is brought to the emergency department because of generalized seizures lasting for 10 minutes.
She has had purulent otitis for the last week, which has been poorly responsive to antibiotic treatment.
Her temperature is 39.5 C (103 F), blood pressure is 140/80 mm Hg, pulse is 86/min, and respirations are 18/min.
She appears oriented and cooperative during physical examination. Funduscopy reveals papilledema.
And tell me the main two bugs responsible for this.

1- Blood cultures for Neiserria
2- EEG studies
3- CT/MRI of the head
4- Lumbar puncture
5- NSAIDS
6- Ciprofloxacin
7- Gentamicin
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  #2  
Old 08-17-2011
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I would do an EEG first.
and about the bugs, for a 13 year old : Pneumococcos and Meningococuss.

I have a question, whats pre-med bound?
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Old 08-17-2011
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Papilledema means there might be an abscess in temporal lobe, so I'll go with 3) CT/MRI
BUgs might be
- strep pneumo
- psedomonas
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  #4  
Old 08-17-2011
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Default i dont get this

i mean no offence, pls can you explain why

1) an eeg is impt, she has generalized sx, if they were focal it would be more in keeping with an abscess.

2) does N. meningitidis cause purulent otitis media, that was stated as a possible focus of entry in this child. are strp and H. influenza not more common causes of otitis media

3) based on her age (13) the following are likely causes of meningitis: NESH (neisseria, enterococci, strp pneumo and HSV). these are more likely in people ages 6-60

i dont know the answer to the question i just would love to know why a particular answer is correct, thanks
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Old 08-17-2011
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Default okay i have checked it up some

i will choose CT/MRI. let me post something i saw:

"The cornerstone in the diagnosis of meningitis is examination of the CSF
In general, whenever the diagnosis of meningitis is strongly considered, a lumbar puncture should be promptly performed.
A computed tomography (CT) scan of the brain may be performed prior to lumbar puncture in some patient groups with a higher risk of herniation. These groups include those made up of patients with the following risk factors:
  • Newly onset seizures
  • An immunocompromised state
  • Signs suspicious for space-occupying lesions (such as papilledema and focal neurologic signs)
  • Moderate to severe impairment in consciousness
so i choose CT/mri
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Old 08-17-2011
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I think, I would go for the Imaging studies first.

As she has papilledema on exam, so she might have raised intracranial pressure and in this situation, doing the LP would increase the chances of herniation.
According to the history, she might have developed the brain abscess secondary to spread of infection from the otitis media.
If there would be an option, I would also start her on the ABx (though Cipro and Genta are not the first line medications).
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Old 08-17-2011
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Sorry, somehow I do not think the question matches the multiple choice. I am wondering where you got the quesiton?
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Old 08-17-2011
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Default Ct/mri

do a CT to examine what Streptococcus Pneumoniae or H. flu or Moraxella c. is doing to this poor girl. One of the most serious complications of sinusitis and otitis is the development of cerebral abscesses. This often manifests with persistent fever, variable neurologic deficits, headache, and seizures. Because of the accompanying edema around the abscess, intracranial pressure may develop, which explains papilledema or ptosis in this case. Cerebral abscesses are life-threatening conditions that often require surgical evacuation right away! Blood cultures are often negative in the case of an isolated cerebral abscess. On the other hand, the surgeon should submit samples for culture in case of surgical intervention. EEG studies may, at best, show non-specific (and thus non-diagnostic) focal changes in the temporal region. Lumbar puncture, as in all situations in which signs of increased intracranial pressure are detected, should be avoided. LP should be avoided in patients with Increased ICT to prevent herniation..

Organism
S.pneumoniae
M.cataharalis
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  #9  
Old 08-20-2011
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CT to avoid herniation
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  #10  
Old 08-22-2011
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Quote:
Originally Posted by nativedoc View Post
i mean no offence, pls can you explain why

1) an eeg is impt, she has generalized sx, if they were focal it would be more in keeping with an abscess.

2) does N. meningitidis cause purulent otitis media, that was stated as a possible focus of entry in this child. are strp and H. influenza not more common causes of otitis media

3) based on her age (13) the following are likely causes of meningitis: NESH (neisseria, enterococci, strp pneumo and HSV). these are more likely in people ages 6-60

i dont know the answer to the question i just would love to know why a particular answer is correct, thanks
" 3) based on her age (13) the following are likely causes of meningitis: NESH (neisseria, enterococci, strp pneumo and HSV). these are more likely in people ages 6-60 "
According to FA pg 225 Infectious Dz, H should be H.I. not HSV.
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