What I Have Learned About Infectious Diseases With My Sleeves Rolled Up

Karen L. Roos, MD


Semin Neurol. 2002;22(1) 

In This Article

Abstract and Introduction


The questions most often asked of my residents and myself are the following: (1) How do you interpret the cerebrospinal fluid white blood cell count and polymerase chain reaction results when the lumbar puncture has been traumatic? (2) Does the older adult with a serum sample that tests positive by the Venereal Disease Research Laboratory test need spinal fluid analysis for neurosyphilis, and which of those syphilis tests can become nonreactive even though the patient is never treated? (3) Do you give steroids to patients with bacterial meningitis? (4) What do you do for the patient with cryptococcal meningitis who develops a spastic gait? (5) Are all cases of transverse myelitis "idiopathic"? and (6) When does the patient who has had a stroke need spinal fluid analysis to rule out an infectious etiology? This is how we answer these questions.

Objectives: Upon completion of this article the reader will be able to know how to interpret spinal fluid in the setting of a traumatic tap, understand how to deal with a positive serum VDRL in an older patient with suspected neurosyphilis, recognize the rationale for use of corticosteroids in patients with bacterial meningitis, recognize the clinical significance of gait spasticity in patients with cryptococcal meningitis, develop an approach for the evaluation of patients with "idiopathic" transverse myelitis, and list the reasons to consider spinal fluid studies in patients with ischemic stroke.
Accreditation: The Indiana University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit: The Indiana University School of Medicine designates this educational activity for a maximum of 1.0 hours in category one credit toward the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

Disclosure: Statements have been obtained regarding the author's relationships with financial supporters of this activity. There is no apparent conflict of interest related to the context of participation of the author of this article.


At the beginning of a career, much of what a physician knows has come from lectures and textbooks. At the midpoint in a career, how a physician practices medicine comes from applying that knowledge to years of caring for patients. This is what I have learned.


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