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. 2022 Nov 14;22(1):426.
doi: 10.1186/s12883-022-02927-4.

Seizures in adults with suspected central nervous system infection

Sabine E Olie  1 , Ingeborg E van Zeggeren  1 , Liora Ter Horst  1 ; I.-PACE Study Group; Diederik van de Beek  1 , Matthijs C Brouwer  2
Collaborators, Affiliations

Seizures in adults with suspected central nervous system infection

Sabine E Olie et al. BMC Neurol. .

Abstract

Background: Seizures can be part of the clinical presentation of central nervous system (CNS) infections. We describe patients suspected of a neurological infection who present with a seizure and study diagnostic accuracy of clinical and laboratory features predictive of CNS infection in this population.

Methods: We analyzed all consecutive patients presenting with a seizure from two prospective Dutch cohort studies, in which patients were included who underwent cerebrospinal fluid (CSF) examination because of the suspicion of a CNS infection.

Results: Of 900 episodes of suspected CNS infection, 124 (14%) presented with a seizure. The median age in these 124 episodes was 60 years (IQR 45-71) and 53% of patients was female. CSF examination showed a leukocyte count ≥ 5/mm3 in 41% of episodes. A CNS infection was diagnosed in 27 of 124 episodes (22%), a CNS inflammatory disorder in 8 (6%) episodes, a systemic infection in 10 (8%), other neurological disease in 77 (62%) and in 2 (2%) episodes another systemic disease was diagnosed. Diagnostic accuracy of clinical and laboratory characteristics for the diagnosis of CNS infection in this population was low. CSF leukocyte count was the best predictor for CNS infection in patients with suspected CNS infection presenting with a seizure (area under the curve 0.94, [95% CI 0.88 - 1.00]).

Conclusions: Clinical and laboratory features fail to distinguish CNS infections from other causes of seizures in patients with a suspected CNS infection. CSF leukocyte count is the best predictor for the diagnosis of CNS infection in this population.

Keywords: CNS infection; Cerebrospinal fluid; Diagnostic accuracy; Epilepsy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Diagnosis in patients with suspected neurological infections presenting with seizures. † 1 Neurocysticercosis, 1 cerebral toxoplasmosis, 1 cerebral Whipple’s disease, ‡ 1 anti-N-methyl-D-aspartate (NMDA), 1 anti-Leucine-Rich Glioma-Inactivated1 (LGI1) and 3 seronegative, § 1 cerebral vasculitis, 1 neuro systemic lupus erythematosus (SLE), 1 Acute disseminated encephalomyelitis (ADEM), • 3 status post CNS infection, 1 hypertensive encephalopathy, 1 encephalopathy due to thrombotic thrombocytopenic purpura. ¶̊ 1 skin/soft tissue infection, 1 abdominal infection, 1 bacteremia
See this image and copyright information in PMC

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