Severe CNS Infections are time dependent diagnoses! You must have a high index of suspicion, a good plan for your work-up, and rapid provision of treatment. After seeing a severely ill meningitis patient, I figured I would do a podcast on some tips and pearls on this topic.
When to Suspect
Here is the article I mentioned on establishing pretest prob:
Ceftriaxone 2g as empiric therapy in any suspected meningitis patient
If high risk or LP results are positive, also give
- Vancomycin 1 G
- Ampicillin 2g if age > 50 y/o
- Acyclovir 10 mg/kg if high RBC count, obtundation, seizures, or focal neurologic deficit
- Dexamethasone 10 mg
- Cefepime or Imipenem if hospitalized or neurosurgery patient
listen to the podcast for more and see the EMCrit chapter for more.
photo by Lapoland
Def. give Dex. (PMID: 12432041)