Infectious meningitis and encephalitis are often life-threatening illnesses, though prompt workup and targeted treatment can greatly reduce morbidity and mortality. Although presentation of central nervous system infection can sometimes be subtle, our recent issue Emergency Department Management of Adults With Infectious Meningitis and Encephalitis focuses on evidence-based strategies for identifying combinations of signs and symptoms to narrow the diagnosis.
Identifying meningitis versus encephalitis; bacterial versus viral, fungal, or iatrogenic causes; and providing prompt empiric antimicrobials and appropriate diagnostic testing are key to management. Cerebrospinal fluid testing findings are outlined to help determine a potential cause for symptoms, along with blood and serum testing options. International society guidelines and evidence regarding the need for computed tomography prior to lumbar puncture are presented, which can help reduce unnecessary imaging.
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Here are a few key points:
- Meningitis refers to inflammation of the meninges; encephalitis refers to inflammation of the brain parenchyma.
- The presence of focal neurological signs (seizure, motor weakness, aphasia, neuropsychiatric symptoms, or dysautonomia) indicates involvement of brain tissue and encephalitis.
- Prehospital providers exposed to bacterial pathogens should receive postexposure prophylaxis. See Table 4 in the issue for recommended regimens.
- No single symptom can differentiate meningitis from other disease processes.