Meningitis, encephalitis in clinical paediatric practice
Erratic breathing pattern
Petechial rash (but with normal platelets and coagulation)
Hypertension
Double vision
Impaired conscious level
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CT scanning is a good way of excluding raised intracranial pressure
Antibiotics prior to LP make it difficult to diagnose bacterial meningitis
Blood cultures are not very useful in meningitis
Latex antigen tests are helpful when culture/microscopy are negative
Coning can happen in meningitis without lumbar puncture
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CSF Protein = 1
CSF Glucose = 2.5
Blood WBC = 25
CRP = 50
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He should have an LP to exclude meningitis
Seizures can cause CSF abnormalities even if there is no CNS infection
Partial, multiple or prolonged (over 30 mins) seizures make the diagnosis of febrile convulsion less likely
Classic meningism may not be detected in infants with meningitis
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A history of previous cold sores makes HSV unlikely
With aciclovir, mortality is less than 10%
Aphasia and focal neurological signs are common
Long term complications are common in survivors
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EEG is abnormal in more than 80%
EEG abnormalities are seen particularly in the temporal lobes
MRI is the best imaging technique
Normal CSF and negative PCR excludes HSV encephalitis
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Varicella zoster virus; encephalitis can occur without chickenpox rash
Enterovirus; cause winter epidemics
Mumps and measles; if unimmunized
West Nile Virus is an important cause of encephalitis in Florida
Acute disseminated encephalomyelitis (ADEM) is distinguised by spinal cord signs and multiple focal white matter abnormalities
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