Vancomycin and ceftazidime are used in post–head trauma patients, neurosurgical patients, or ventriculoperitoneal shunts. Antifungal agents should be considered in HIV+ and other immunocompromised patients.
CNS Encephalitis
DEFINITION Inflammation of the brain parenchyma secondary to infection. CAUSES Usually viral in origin. SIGNS AND SYMPTOMS
Abnormal behaviors and “personality changes” Seizures Headache Photophobia Focal neurologic findings Signs of peripheral disease: Herpes—skin vesicles, rash Rabies—animal bite Arboviruses—bug bite
Causes of encephalitis: HEAR Herpes Epstein–Barr virus Arboviruses Rabies
HIGH-YIELD FACTS
DIAGNOSIS
TREATMENT
Mainly supportive Acyclovir for herpes
DO NOT delay antibiotics for LP or head CT when meningitis is suspected.
Brain Abscess
DEFINITION A focal purulent cavity, covered by granulation tissue located in the brain. CAUSES Brain abscesses develop secondary to: Hematogenous spread Contiguous infections (sinuses, ears) Direct implantation via penetrating trauma or neurosurgery SIGNS AND SYMPTOMS
Headache Fever Focal neurologic findings Signs of primary infection History of trauma
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Neurologic Emergencies
Primarily diagnosed via CSF culture or serology: Blood in the CSF is a nonspecific clue but suggests herpes.