Severe CNS infections are a bit of an orphan disease in critical care. Unlike more common neurologic disorders (e.g. stroke), CNS infections are too rare to recruit lots of patients into RCTs. Consequently, conventional treatment of these disorders lags decades behind other neurologic disorders (e.g. in terms of optimizing cerebral perfusion pressure). Principles of neurocritical care can be applied to these patients, but it requires a leap of faith. Meanwhile, getting the basics right is the most important aspect – prompt diagnosis, appropriate empiric antibiotics, and definitive neuroimaging.
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