Neurocritical care of patients with central nervous system infections

Abstract

Bacterial meningitis and viral encephalitis are life-threatening infections with high mortality rates. Patients who survive these infections often remain permanently disabled. Potential neurologic complications requiring careful attention include impaired consciousness, elevated intracranial pressure, hydrocephalus, stroke, and seizures. Systemic complications are also common and are frequently the immediate cause of death. Critical care of these patients should focus not only on treatment of the underlying infection and its immediate complications but also on minimizing secondary brain injury. Given the increasing complexity of the diagnostic and therapeutic modalities available in managing central nervous system infections, the involvement of neurocritical care units and neurointensivists may be particularly helpful in improving outcomes.

Efficacy of CMX001 against Herpes Simplex Virus Infections in Mice and Correlations with Drug Distribution Studies

“…Herpes simplex virus (HSV) infects approximately 1500 neonates annually, many of whom will have central nervous system disease, and HSV encephalitis occurs in children over 6 months of age and in adults at 1 in 150,000 annually in the US [1-5]. Rapid diagnosis and early intervention with acyclovir (ACV) have improved survival and decreased long term neurological sequelae; however, mortality still exceeds 25% and over 50% of survivors have significant neurologic impairment [5-17].…”

Viral-like brain inflammation during development causes increased seizure susceptibility in adult rats

“…Encephalitis is normally defined as acute inflammation of the brain parenchyma caused by a CNS infection which often results in significant morbidity, long-term disability, and can be fatal (Kramer and Bleck, 2008). The majority (~60%) of acute encephalitis cases have unknown causes, however, in the known cases, viruses are the most common etiological agent (Chen et al, 2006;Davison et al, 2003;Khetsuriani et al, 2002;Kramer and Bleck, 2008;Whitley, 1990).…”

“…The majority (~60%) of acute encephalitis cases have unknown causes, however, in the known cases, viruses are the most common etiological agent (Chen et al, 2006;Davison et al, 2003;Khetsuriani et al, 2002;Kramer and Bleck, 2008;Whitley, 1990). Most concerning is that the incidence of viral encephalitis in children is almost three times that of adults suggesting that this portion of the population is particularly susceptible (Beghi et al, 1984;Davison et al, 2003;Nicolosi et al, 1986).…”

Bacterial meningitis after tooth extraction

“…Because a bacterial meningitis still represents a highly threatening clinical picture 14,15 , immediate diagnosis (blood cultures and CSF samples) and therapy are indispensable. 16 The typical clinical signs of meningitis are severe headaches, neck stiffness and fever.…”