Bacterial Infections of the Central Nervous System

Paul A. LaPenna, DO; Karen L. Roos, MD


Semin Neurol. 2019;39(3):334-342. 

In This Article


Acute bacterial meningitis and spinal epidural abscess are neurological emergencies. When bacterial meningitis is suspected, empiric antimicrobial therapy is initiated while awaiting the results of blood cultures and spinal fluid analysis. Emergent neuroimaging is indicated in every patient with back pain and fever. The level of the neuroaxis to image is determined by the neurological examination, most notably the presence of a sensory level and appendicular weakness involving the arms, the legs, or both. A brain abscess typically presents with fever, headache, and vomiting. DWI can be very helpful in distinguishing an abscess from a tumor, although both require biopsy for management. There is no need for a neurologist to defer the diagnosis and management of a bacterial CNS infection to an infectious disease physician. The knowledge a neurologist has is critical to emergent diagnosis of these life-threatening infections and the management of the complications that so significantly affect morbidity and mortality.