Central nervous system infections: A critical care approach

Abstract

Central nervous system (CNS) infections are diverse. CNS infections can cause significant morbidity and mortality and are markedly different from systemic infections. The closed anatomic space of the CNS, its immunologic isolation from the rest of the body, and the often nonspecific nature of the key manifestations present a challenge to the clinician. Early recognition and aggressive management are essential to patient recovery and prevention of long-term neurologic sequelae. This review discusses the major types of CNS infections and focuses on critical care management, with emphasis on current epidemiologic trends.

Encefalitis herpética en adultos: 23 casos

“…La asociación con corticoides es controvertida, los defensores la utilizan con la esperanza de disminuir el edema cerebral por su efecto antiinflamatorio potente, sus detractores propugnan que su acción inmunosupresora favorece la replicación del virus y la diseminación al sistema nervioso (29). Los anticomiciales se utilizan en caso de que aparezcan crisis convulsivas, siendo de elección la fenitoína, no existen datos para utilizarlo de forma profiláctica; incluso algunos autores no los consideran necesarios ya que muchos de los pacientes que los precisarían están ingresados en una UCI y la gran mayoría con medicación sedante con propiedades anticonvulsivantes (30,31). La cirugía descompresiva estaría indicada en aquellos individuos que presentan herniación uncal o aumentos incontrolables de la presión intracraneal (32).…”

Central Nervous System Infections in the Critically Ill

“…These infections typically occur as a result of trauma and neurosurgery, but other sources such as meningitis, sinusitis, and other extracranial sources have been implicated. 110 The most common infectious etiologies include streptococci, staphylococci, and anaerobes, and infections are often polymicrobial. 16,111 Empiric treatment of cranial epidural abscess consists of broad-spectrum antibiotics, usually in combination with surgical drainage to prevent development of subdural empyema.…”

“…19 In addition, it is frequently associated with the presence of a CSF shunt, extraventricular drain (EVD), or other intracranial devices. 110 EVDs are important neurosurgical instruments that provide continuous measurement of ICP as well as therapeutic drainage of CSF. The risk of developing ventriculitis with an EVD in place is reported to be as high as 45% but more commonly reported in the 10% to 15% range, and it is dependent on the type of EVD, insertion technique, management, and length of time the EVD is in place.…”