SEIZURES/MENINGITIS

MENINGITIS
SEIZURES

ETIOLOGY
Febrile Seizures
— Bacteria
o Streptococcus pneumoniae
o Neisseria meningitidis
— 6-60 months old
o Hemophilus influenza type b
— Temp ≥ 38˚C
— Viruses
— No CNS, metabolic problem; (+) fever o Enteroviruses

— Fungal

— Parasitic

SSx
Febrile Seizures
— Fever — Back pain
— Headache — Nuchal rigidity
Simple Complex
— Nausea — Kernig Sign
— Generalized, tonic- — Focal
clonic — Vomiting — Brudzinski sign
— Duration: 15 mins — Duration: >15 mins — Anorexia — Seizures
max
— Confusion — Behavioral
— Frequency: once/24 abnormalities
hrs — Recurs in 24 hours
 Diagnosis Lumbar Puncture

— LP
o Staining: gram, india ink, AFB; Culture
o Sugar, protein
o Total and differential cell count

— CT/MRI
— Blood culture
o H flu 80%
o Pneumococcal 52%
o Meningococcal 33%

Lumbar Puncture Complications

— Seizures — Hearing loss

— Increased ICP — Cognitive impairment

— Cranial nerve palsies — Delay in acquisition of

language
— Stroke
— Visual impairment
— Herniation
— Behavioral problems

Lumbar Puncture Treatment

ORGANISMS ANTIBIOTIC DURATION

S. pneumoniae Penicillin G 10-14 days
N. Meningitidis Penicillin G 7 days
H. influenzae Chloramphenicol or 7-10- days
Ceftriaxone
E. coli Cefotaxime or 3-6 weeks
Imipenem/Meropenem
Grp B. Strep Penicillin +/- Gentamicin 2-3- weeks
 Prevention

1. Vaccination
2. Antibiotic prophylaxis
N. meningitidis:
v Rifampicin 10 mg/kg/dose q12H for 2 days
v Ceftriaxone IM SD
v Ciprofloxacin 500 mg SD
H. influenzae:
v Rifampicin 20 mg/kg/dose OD x 4 days