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Review
. 2016 Nov;34(4):917-942.
doi: 10.1016/j.emc.2016.06.013.

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Maia Dorsett  1 , Stephen Y Liang  2
Affiliations
Review

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Maia Dorsett et al. Emerg Med Clin North Am. 2016 Nov.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Emerg Med Clin North Am. 2017 May;35(2):xix. doi: 10.1016/j.emc.2017.02.001. Emerg Med Clin North Am. 2017. PMID: 28411939 No abstract available.

Abstract

Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with nonspecific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. Neuroimaging and CSF fluid analysis can appear benign early in the course of disease. Delaying therapy negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis. Therefore, diagnosis of CNS infection requires vigilance and a high index of suspicion based on the history and physical examination, which must be confirmed with appropriate imaging and laboratory evaluation.

Keywords: Brain abscess; Diagnosis; Emergency department; Encephalitis; Meningitis; Treatment.

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Conflict of interest statement

M.D. and S.Y.L. report no conflicts of interest in this work.

Figures

Figure 1
Figure 1. Algorithm for Diagnostic Workup of Encephalitis in the Emergency Department Setting
CBC = Complete Blood Count; CMP = Complete Metabolic Panel; PT/PTT= Prothrombin Time/Partial Thromboplastin Time; HSV = Herpes Simplex Virus; VZV = Varicella Zoster Virus; CMVCytomegalovirus; PCR = Polymerase Chain Reaction
Figure 2
Figure 2. Work-up for presumed CNS infection in a patient with advanced HIV disease
Modified from {Lin Tan 2012}. EBV = Epstein Barr Virus; CMV = Cytomegalovirus; HSV = Herpes Simplex Virus; VZV = Varicella Zoster virus; IgG = immunoglobulin G.
See this image and copyright information in PMC

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MeSH terms