Central nervous system infections in the intensive care unit

Infections of the central nervous system are a frequent cause for admission to the intensive care unit (ICU). These infections can be the reason for presentation to a hospital or a complication of an injury or surgical procedure. Diagnosing these infections can be very challenging, given the relative paucity of tests with high sensitivity and specificity. Regardless, identifying and treating the underlying cause remains the primary objective in each of these cases, but management of complications is the most common reason for ICU admission. Frequent complications include increased intracranial pressure, stroke, coma, and status epilepticus. Although the underlying infection often causes harm, the immune response to the agent and ensuing complications are often responsible for greater damage to the host. Even if the underlying infectious agent does not have a specific therapy, identifying it is important for limiting unnecessary testing. When certain infections are suspected, such as bacterial meningitis or viral encephalitis, empiric therapy should be initiated immediately. Outcomes for these conditions are linked to how quickly appropriate therapies are initiated.