By Michael Aminoff, David Greenberg, Roger Simon
Well-known for a practice-oriented method of neurology in accordance with the patient�s featuring indicators or symptoms. This uniquely readable and concise booklet presents a powerful origin in simple neuroscience linking it to present methods within the prognosis and therapy of neurologic issues. positive factors new proper sites and a word list in addition to wide use of charts and tables.
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Additional info for Clinical Neurology
Etiologic agents and empirical antibiotic treatment in bacterial meningitis, based on age and predisposing condition. Age or Condition Etiologic Agents Antibiotics of Choice Less than 3 months S agalactiae E coli L monocytogenes Ampicillin, 100 mg/kg intravenously every 8 hours + cefotaxime, 50 mg/kg intravenously every 6 hours or ceftriaxone, 50–100 mg/kg intravenously every 12 hours 3 months to 8 years N meningitidis S pneumoniae H inﬂuenzae Cefotaxime, 50 mg/kg intravenously every 6 hours or ceftriaxone, 50–100 mg/kg intravenously every 12 hours + vancomycin, 15 mg/kg intravenously every 6 hours, to maximum of 4 g/d 18 to 50 years S pneumoniae N meningitidis Cefotaxime, 2 g intravenously every 6 hours or ceftriaxone, 2 g intravenously every 12 hours + vancomycin, 15 mg/kg intravenously every 6 hours, to maximum of 4 g/d Older than 50 years S pneumoniae L monocytogenes Gram-negative bacilli Ampicillin, 2 g intravenously every 4 hours + cefotaxime, 2 g intravenously every 6 hours or ceftriaxone, 2 g intravenously every 12 hours Impaired cellular immunity L monocytogenes Gram-negative bacilli Ampicillin, 100 mg/kg intravenously every 8 hours (neonate) or 2 g intravenously every 4 hours (adult) + ceftazidime, 50–100 mg/kg intravenously every 8 hours, to maximum of 2 g every 8 hours Head trauma, neurosurgery, or CSF shunt Staphylococci Gram-negative bacilli S pneumoniae Vancomycin, 15 mg/kg intravenously every 6 hours, to maximum of 4 g/d + ceftazidime, 50–100 mg/kg intravenously every 8 hours, to maximum of 2 g every 8 hours Adapted from Quagliarello VJ, Scheld WM: Treatment of bacterial meningitis.
Infections may be complicated by adrenal hemorrhage related to meningococcemia, resulting in hypotension and often death (Waterhouse-Friderichsen syndrome). Morbidity and mortality from bacterial meningitis are high. Fatalities occur in about 20% of affected adults, and more often with some pathogens (eg, S pneumoniae, gram-negative bacilli) than others (eg, H inﬂuenzae, N meningitidis). Factors that worsen prognosis include extremes of age, delay in diagnosis and treatment, complicating illness, stupor or coma, seizures, and focal neurologic signs.
Acute management includes hydration, protein and salt restriction, and treatment of complications such as seizures. Long-term management requires reversing the cause (eg, urinary tract obstruction), dialysis, or kidney transplantation. Although dialysis reverses the encephalopathy, clinical improvement often lags behind normalization of serum urea nitrogen and creatinine. Dialysis itself can produce an encephalopathy, termed dialysis disequilibrium syndrome, that is thought to result from hypoosmolality.