CURRENT Essentials of Critical Care.pdf

138 Current Essentials of Critical Care■■■Encephalitis, Brain Abscess,Spinal Epidural AbscessEssentials of Diagnosis• Encephalitis: altered sensorium, headache, fever, sometimesprogressing to stupor, coma, occasionally seizures, focal neurologicsigns; Herpes simplex most common sporadic viral encephalitis;arboviruses, West Nile virus• Brain abscess: fever, seizures, focal neurologic signs, progressiveobtundation; abnormal head CT (with radiographic contrast)or MRI; may have local infection (otitis media, sinusitis,dental infection)• Spinal epidural abscess: fever, back pain, radiculopathy, progressivemotor or sensory deficits depending on location, percussiontenderness; may have adjacent osteomyelitisDifferential Diagnosis• CNS tumor (primary or metastatic to spine or brain)• Bacterial or viral meninigitis• Fungal or tuberculous infection, especially in immunocompromisedhost• Vasculitis or collagen vascular diseasesTreatment• Evaluate for CNS or spinal cord mass effect or compression• High-dose acyclovir for herpes encephalitis• Surgical drainage for spinal epidural abscess• Antibiotics for epidural abscess active against staphylococci,streptococci, gram-negative bacilli; for brain abscess activeagainst streptococci plus anaerobes■ PearlBrain abscesses arising from the oral cavity and frontal or ethmoidsinuses tend to locate in the frontal lobes of the brain; hematologicallyseeded abscesses are more often multiple and occur in the areasupplied by the middle cerebral artery.ReferenceBeaman MH: Acute community-acquired meningitis and encephalitis. Med JAust 2002;176:389. [PMID: 12041637]