Author: Anna Shekhdar / Editor: Michael John Stewart / Reviewers: Michael Perry, Amanda King / Codes: A5, O3, R2, R3 /
Published: 12/06/2020
Description:
Intracranial infections (also called central nervous system infections or CNS infections) are relatively rare, but form a very important differential diagnosis in the unwell patient. It is essential to suspect and expedite treatment because consequences of a missed CNS infection are severe.
After completing this session you will be able to:
- Identify the major causes of CNS infection
- Distinguish between those seen in immunocompromised and non-immunocompromised patients, and highlight those of particular concern in people returning from travel abroad
- Explain how to differentiate, on clinical grounds, the relevant infections in the above groups
- Formulate a pragmatic approach to the investigations required to determine the cause
- Explain the current treatment recommendations for the most important causes of intracranial infection
References:
- RUND, D.A. et al. (1996) Essentials of Emergency Medicine C.V. Mosby.
- VAN DE BEEK, D., DE GANS, J., MCINTYRE, P. et al. (2007) Corticosteroids for acute bacterial meningitis. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD004405. DOI: 10.1002/14651858.CD004405.pub2.
- LOGAN, S., and MACMAHON, E. (2008) Clinical Review. Viral Meningitis. BMJ, 336, pp. 36-40.
- CONTERNO, L.O., DA SILVA FILHO, C.R., RUGGEBERG, J.U. et al. (2006) Conjugate vaccines for preventing meningococcal C meningitis and septicaemia. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD001834. DOI: 10.1002/14651858.CD001834.pub2.
- RAMACHANDRAN, T. (2008) EMedicine: Tuberculous Meningitis. Available here.
- ATTIA, J., HATALA, R., COOK, D, et al. (1999) Does this adult patient have acute meningitis? Database of Abstracts of Reviews of Effects. JAMA, 282(2), pp. 175-181.
- KUPILA, L., VUORININ, T., VAINIONPAA, R. et al. (2006) Etiology of aseptic meningitis and encephalitis in an adult population. Neurology, 66, pp. 75-80.
- CASSADY, K. and WHITLEY, R.J. (2004) Pathogenesis and pathophysiology of viral infections of the central nervous system. In: Scheld, W.M., Whitley, R.J., Marra, C.M., eds. Infections of the central nervous system. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, pp. 57-74.
- SAWYER, M.H. and ROTBART, H. (2004) Viral Meningitis and aseptic meningitis syndrome. In: Scheld, W.M., Whitley, R.J., Marra, C.M., eds. Infections of the central nervous system, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, pp. 75-93.
- NEWTON, C., TAYLOR, T. and WHITTEN, R. (1998) Pathophysiology of fatal falciparum malaria in African Children. Am. J. Trop. Med. Hygiene, 58(5), pp. 673-683.
- MOLYNEUX, M. (2000) Impact of malaria on the brain and its prevention. The Lancet, Feb 26, 355, issue 9205, pp. 671-672.
- WHITE, N. White N, (1996) Review Article: The treatment of malaria. The New England Journal of Medicine, Vol 335, pp. 800-806.
- READ, S.J. and KURTZ, J.B. (1999) Laboratory diagnosis of common viral infections of the central nervous system by using a single multiplex PCR screening assay. J Clin Microbiol, 37, pp.1352-1355.
- TURNER, T. and HARRIS, C. (2003). Risk of cerebral herniation due to lumbar puncture in children with suspected meningitis. (The Centre for Clinical Effectiveness). Available here.
- PRASAD, K., KUMAR, A., SINGHAL, T. et al. (2007) Third generation cephalosporins versus conventional antibiotics for treating acute bacterial meningitis. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD001832. DOI: 10.1002/14651858.CD001832.pub3.
- MCINTYRE, P.B., BERKLEY, C.S., KING, S.M. et al. (1997) Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomised clinical trials since 1988. JAMA, 278, pp. 925-931.
- MCGEE, S. and HIRSCHMANN, J. (2008) Use of corticosteroids in treating infectious diseases. Archives of internal medicine, 26 May, Vol 168, no 10, pp. 1034-1046.
- MEREMIKWU, M and MARSON, A.G. (2002) Routine anticonvulsants for treating cerebral malaria. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD002152. DOI: 10.1002/14651858.CD002152.
- MACONOCHIE, I.K., BAUMER, J.H and STEWART, M. (2008) Fluid therapy for acute bacterial meningitis. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD004786. DOI: 10.1002/14651858.CD004786.pub3.
- CROFT, A. (2000) Malaria: prevention in travellers. BMJ Clinical Review BMJ, 321, pp. 154-160.
- Ropper, Allan H.; Dalmau, Josep; Graus, Francesc (March 2018). “Antibody-Mediated Encephalitis”. New England Journal of Medicine. 378 (9): 840851. doi:10.1056/NEJMra1708712. PMID29490181.
Useful link:
- Meningitis Research Foundation: View website