Management of cerebral infection

• Cerebral infection may be due to meningitis, encephalitis, or focal space occupation.

• Viral meningitis must be distinguished from partly treated bacterial and other causes of aseptic meningitis.

• Viral encephalitis in the UK and Europe is usually due to herpes simplex which must be treated quickly with intravenous acyclovir. However other causes must be considered including, especially in other parts of the world, rabies and arborviruses.

• At seroconversion HIV infection may cause aseptic meningoencephalitis and later it may cause HIV encephalopathy. AIDS is associated with cytomegalovirus, toxoplasmosis, progressive multifocal leukoencephalopathy, and tuberculosis.

• Bacterial meningitis is a serious neurological emergency. The commonest causative organisms, except in neonates and the elderly, are Neisseria meningitidis and Streptococcus pneumoniae. Immediate treatment should be given to adult patients with ceftriaxone. Advice about other antibiotic treatment is contained in this chapter.

• Cerebral malaria is fatal in 25-50% of cases. Patients with febrile illnesses returning from malarial areas should be suspected of having malaria. Quinine is the drug of choice for severe malaria.

• Cerebral abscess may be caused by a wide variety of organisms but Streptococci are the commonest in non-immunocompromised hosts. Most patients require surgical drainage and empirical treatment with antibiotics. These usually include a third generation cephalosporin, metranidazole, and, if Staphylococci are suspected, vancomycin.

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