How to treat Acute Bacterial Infection?

Clinical Features and Treatment of Bacterial Infection:

In most cases the infection causing meningitis arises in the nasopharynx intravascular invasion (bacteraemia) and penetration of the blood brain barrier follow mucosal involvement with entry into the CSF. Bacteria may invade the subarachnoid space directly by spread from contiguous structures, e.g. sinuses and fractures. Specific characteristics of the capsule determine whether meninges are breached. Humoral defences against bacteria are absent in the CSF offering little resistance to infection.

Clinical Features

The classical clinical traid is

• Fever
• Headache
• Neck stiffness

Prodromal Features

A respiratory infection otitis media or pneumonia associated with muscle pain.

Meningitic Symptoms

• Severe frontal/occipital headache
• Stiff neck
• Photophobia

Investigations

• If patient has altered consciousness, focal signs, papilloedema, and a recent seizure or is immunocompromised a CT brain should be done before LP. However, do not delay treatment -take blood cultures and commence antibiotics prior to scanning.
• If above signs are absent or CT scan excludes a mass lesion confirm diagnosis with a lumbar puncture and identify the organism.

Treatment

• Once meningitis is suspected, treatment must commence immediately, often before identification of the causative organism.
• Antibiotics must penetrate CSF, be in appropriate bactericidal dosage and be sensitive to causal organism once identified.

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How to prevent Anterior Cerebral Artery (Stroke)?

Clinical Features of Anterior Cerebral Artery:

The anterior cerebral artery is a branch of the internal carotid and runs above the optic nerve to follow the curve of the corpus callosum. Soon after its origin the vessel is joined by the anterior communicating artery. Deep branches pass to the anterior part of the internal capsule and basal nuclei. Cortical branches supply the medial surface of the hemisphere:

• Orbital
• Frontal
• Parietal

Clinical Features

The anterior cerebral artery may be occluded by embolus or thrombus. The clinical picture depends on the site of occlusion (especially in relation to the anterior communicating artery) and anatomical variation, e.g. both anterior cerebral arteries may arise from one side by enlargement of the anterior communicating artery.

Occlusion proximal to the anterior communicating artery is normally well tolerated because of the cross flow.

• Distal occlusion results in weakness and cortical sensory loss in the contralateral lower limb with associated incontinence. Occasionally a contralateral grasp reflex is present.
• Proximal occlusion when both anterior cerebral vessels arise from the same side results in ‘cerebral’ paraplegia with lower limb weakness, sensory loss, incontinence and presence of grasp, snout and palmomental reflexes.

Bilateral frontal lobe infarction may result in akinetic mutism or deterioration in conscious level.

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