Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-05-15T01:56:58.742Z Has data issue: false hasContentIssue false

Chapter 14 - Infections of the Central Nervous System

from Section 3 - Specific Neurological Disorders in Emergency Medicine

Published online by Cambridge University Press:  10 January 2024

By
Zaw Min ,
Richard M. Kaplan ,
Kate DeAntonis  and
Evelina Krieger
Edited by
Thomas P. Campbell  and
Kevin M. Kelly
Thomas P. Campbell
Affiliation:
Allegheny Health Network, Pittsburgh
Kevin M. Kelly
Affiliation:
Allegheny Health Network, Pittsburgh
Get access

Summary

Central nervous system infections are typically transmitted hematologically or by contiguous spread. Frequently, there is colonization of the upper respiratory tract, invasion across the epithelium, and then activation of the complement cascade. Polymorphonuclear leukocytes and the cytokines reduce the blood–brain barrier (BBB) integrity and the host defenses. Pathogens invade the meninges, resulting in inflammation and an increased BBB permeability. A subsequent inflammatory response by neutrophils creates edema and increased intracranial pressure, CNS tissue ischemia, and hydrocephalus. Clinical features of meningitis depend upon the age and health status of the patient, the specific pathogen, and the duration of illness. Diagnosing a CNS infection in infants and young children or in patients with nonspecific signs and symptoms is a challenge in the emergency department (ED). A thorough history and physical examination should help lead to a clinical suspicion of a CNS infection.

Keywords

vaccination historynuchal rigiditybrudzinski signtraumatic lumbar puncturechemoprophylaxisaseptic meningitisneurosyphilis
Type
Chapter
Information
Handbook of Emergency Neurology , pp. 207 - 226
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Banks, JT, Bharara, S, Tubbs, RS, et al. Polymerase chain reaction for the rapid detection of cerebrospinal fluid shunt or ventriculostomy infections. Neurosurgery 2005;57:1237–1243.Google Scholar
Beckham, JD, Tyler, KL. Encephalitis. In Bennett, J, Dolin, R, Blaser, M (eds.) Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 9th ed. Elsevier, 2020.Google Scholar
Bhimraj, A. Acute community-acquired bacterial meningitis: an evidence-based review. Cleveland Clin J Med 2012;79:393–400.CrossRefGoogle ScholarPubMed
Brouwer, MC, Thwaites, GE, Tunkel, AR, Van de Beek, D. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis. Lancet 2012;380(9854):1684–1692.Google Scholar
Brouwer, MC, Tunkel, AR, McKhann, GM 2nd, Van de Beek, D. Brain abscess. N Engl J Med 2014;371(5):447–456.Google Scholar
Centers for Disease Control and Prevention. ACIP: Advisory Committee on Immunization Prac-tices. Available at: www.cdc.gov/vaccines/acip.Google Scholar
de Gans, JD, Van de Beek, D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002;347:1549–1556.Google Scholar
Davis, IRC, McNeil, SA, Allen, W, MacKinnon-Cameron, D, et al. Performance of a Modified Two-Tiered Testing Enzyme Immunoassay Algorithm for Serologic Diagnosis of Lyme Disease in Nova Scotia. J Clin Microbiol. 2020;58(7):e01841-19. Google Scholar
Engorn, B, Flerlage, J (eds.) The Harriet Lane Handbook: A Manual For Pediatric House Officers. Mosby Elsevier, 2015.Google Scholar
Fitch, MT, Van de Beek, D. Emergency diagnosis and treatment of adult meningitis. Lancet 2007;7:191–200.CrossRefGoogle ScholarPubMed
Halperin, JJ, Shapiro, ED, Logigian, E, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2007;69(1):91–102.CrossRefGoogle Scholar
Hasbun, R, Abrahams, J, Jekel, J, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001;345:1727–1733.Google Scholar
Hasburn R, Van, de Beek D, Brouwer MC,Tunkel AR, Acute meningitis. In Bennett, J, Dolin, R, Blaser, M (eds.) Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 9th ed. Elsevier, 2020.Google Scholar
Lantos, PM, Rumbaugh, J ,Bockenstedt, LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis 2021;72(1);e1–e48.Google Scholar
Lindsey, NP, Lehman, JA, Staples, JE, Fischer, M. West Nile virus and other arboviral diseases: United States, 2013. MMWR Morb Mortal Wkly Rep 2013;63(24):521–526.Google Scholar
Mead, P, Petersen J, Hinckley A. Updated CDC Recommendation for Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep. 2019;68(32):703.Google Scholar
MMWR, October 23, 2015, Vol 64 #41. Use of serogroup B meningococcal vaccines in adolescents and young adults: recommendations of the Advisory Committee on Immunization Practices, 2015. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm6441a3.htm.Google Scholar
MMWR, March 22, 2013, Vol 62 #2. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices, 2013. Available at: www.cdc.govwww.cdc.gov/mmwr/ preview/mmwrhtml/mm6441a3.htm.Google Scholar
O'Halloran, JA, Franklin, A, Lainhart, W, et al. Pitfalls Associated With the Use of Molecular Diagnostic Panels in the Diagnosis of Cryptococcal Meningitis. Open Forum Infect Dis. 2017;4(4):ofx242.Google Scholar
Patel, K, Clifford, DB. Bacterial brain abscess. Neurohospitalist 2014;4(4):196–204.Google Scholar
Perfect, JR, Dismukes, WE, Dromer, F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious Diseases Society of America. Clin Infect Dis 2010;50(3):291–322.CrossRefGoogle ScholarPubMed
Petersen, LR, Marfin, AA, Gubler, DJ. West Nile virus. JAMA 2003;290:524–528.CrossRefGoogle ScholarPubMed
Pickering, LK, ed. American Academy of Pediatrics Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed. Academy of Pediatrics, 2015.Google Scholar
Pizon, AF, Bonner, MR, Wang, HE, Kaplan, RM. Ten years of clinical experience with adult meningitis at an urban academic center. J Emerg Med 2006;30:367–370.Google Scholar
Thigpen, MC, Whitney, CG, Messonnier, NE, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med 2011;364:2016–2025.Google Scholar
Thomas, KE, Hasbun, R, Jekel, J, Quagliarello, VJ. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis 2002;35:46–52.CrossRefGoogle ScholarPubMed
Tunkel, AR. Approach to the patient with central nervous system infection. In Bennett, J, Dolin, R, Blaser, M (eds.) Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 9th ed. Elsevier, 2020.Google Scholar
Tunkel, AR. Brain abscess. In Bennett, J, Dolin, R, Blaser, M (eds.) Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 9th ed. Elsevier, 2020.Google Scholar
Tunkel, AR, Glaser, CA, Bloch, KC, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008;47(3):303–327.Google Scholar
Van de Beek, D, de Gans, J, Spanjaard, L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351:1849–1859.Google Scholar
Van de Beek, D, de Gans, J, Tunkel, AR, et al. Community-acquired bacterial meningitis in adults. N Engl J Med 2006;354:44–53.CrossRefGoogle ScholarPubMed
Van de Beek, D, Drake, JM, Tunkel, AR. Nosocomial meningitis. N Engl J Med 2010;362(2):146–154.Google Scholar
Van de Beek, D, Brouwer, MC, Thwaites, GE, Tunkel, AR. Advances in treatment of bacterial meningitis. Lancet 2012;380(9854):1693–1702.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×