Source / episode info
- **Episode:**88
- **Title:**Divine Intervention Episode 88 – USMLE Step 3/Medicine ITE/ABIM Review Series 3 (Meningitis)
- **Published:**2019-03-23
- Source:Episode page
One-liner
This episode reviews the workup of meningitis using CSF analysis patterns (bacterial vs. viral vs. fungal), outlines empiric antibiotic regimens based on patient risk factors, and details the diagnosis and management of Anti-NMD receptor encephalitis associated with ovarian teratomas.
High-yield summary
- Meningitis Workup Safety: If a patient presents with altered mental status, focal neurological deficits, or signs of increased ICP (e.g., papilledema), perform a CT head before any lumbar puncture to prevent cerebral herniation.
- CSF Analysis Patterns: Bacterial meningitis shows high opening pressure, high WBC count dominated by neutrophils, low glucose, and high protein. Viral meningitis typically has normal CSF parameters (normal glucose/protein) with lymphocytic predominance.
- Empiric Antibiotics: Coverage must be adjusted: standard community-acquired meningitis requires third-generation cephalosporin + vancomycin; immunocompromised or elderly patients require addition of [Listeria] coverage (e.g., penicillin/cefotaxime).
- Anti-NMD Receptor Encephalitis: This autoimmune encephalitis is classically associated with ovarian teratomas and presents with psychiatric symptoms, seizures, and autonomic instability. Treatment involves tumor removal plus immune suppression (steroids, IVIG, Rituximab).
- Brain Abscess Workup: The gold standard imaging test is MRI. If a brain abscess is suspected, never perform an LP unless the mass effect has been ruled out by CT/MRI.
Learning objectives
- Differentiate the CSF findings, clinical presentation, and causative organisms for bacterial, viral, and fungal meningitis.
- Apply appropriate empiric antibiotic regimens for suspected meningitis based on patient risk factors (age, immunocompromise, hospital exposure).
- Recognize the classic association between ovarian teratomas and Anti-NMD receptor encephalitis.
- Understand the critical safety steps in the workup of increased intracranial pressure (ICP) before performing a lumbar puncture.
- Identify the key signs and symptoms of brain abscess requiring advanced imaging (MRI/CT).
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