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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
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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

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