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Review
. 2012 Jan;9(1):124-38.
doi: 10.1007/s13311-011-0086-5.

Neuro-intensive care of patients with acute CNS infections

J David Beckham  1 , Kenneth L Tyler
Affiliations
Review

Neuro-intensive care of patients with acute CNS infections

J David Beckham et al. Neurotherapeutics. 2012 Jan.

Abstract

Infections in the central nervous system (CNS) are caused by a wide range of microorganisms resulting in distinct clinical syndromes including meningitis, encephalitis, and pyogenic infections, such as empyema and brain abscess. Bacterial and viral infections in the CNS can be rapidly fatal and can result in severe disability in survivors. Appropriate identification and acute management of these infections often occurs in a critical care setting and is vital to improving outcomes in this group of patients. This review of diagnosis and management of acute bacterial and viral infections in the CNS provides a general approach to patients with a suspected CNS infection and also provides a more detailed review of the diagnosis and management of patients with suspected bacterial meningitis, viral encephalitis, brain abscess, and subdural empyema.

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Figures

Fig. 1
Fig. 1
Proportions of bacterial meningitis reported from 2003–2007 per age group. Panel A represents data from children and panel B represents data from adults. (Adapted from Thigpen et al. Bacterial meningitis in the United States, 1998–2007. NEJM 2011;64:2016–2025). GBS = Group B Streptococci; Mo = month; Yr = year
Fig. 2
Fig. 2
Typical magnetic resonance imaging (MRI) changes associated with viral encephalitis. (A) Herpes simplex virus type 1 encephalitis with increased T2-weighted signal in bilateral temporal lobes. Increased signal does not extend beyond the insular cortex (black arrow), but does involve the cingulate gyrus (white arrow). (B) Varicella-zoster virus vasculopathy on proton-density MRI scan with multiple areas of infarction in both hemispheres (arrows). (C) West Nile virus encephalitis with increased signal on FLAIR MRI of the basal ganglia (arrows). (D) Enterovirus encephalitis with increased signal intensity on FLAIR MRI in both hemispheres in posterior cerebral hemisphere (arrow). (Adapted from Beckham and Tyler. Encephalitis, 7th ed. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. Churchill Livinstone, Elsevier 2010:1248)
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