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Central nervous system infections in the elderly.

R E Behrman1, B R Meyers, M H Mendelson

  • 1Department of Medicine, Mount Sinai School of Medicine, City University of New York, N.Y.

Archives of Internal Medicine
|July 1, 1989
PubMed
Summary

This study on elderly CNS infections found that while many survived meningitis, altered mental status and incorrect antibiotic treatment increased mortality. Focal infections had a better prognosis.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Geriatrics

Background:

  • Central nervous system (CNS) infections pose significant risks to elderly individuals.
  • Understanding the epidemiology and outcomes of CNS infections in older adults is crucial for effective management.

Purpose of the Study:

  • To review the characteristics and outcomes of central nervous system infections in patients aged 65 years and older.
  • To identify factors associated with mortality in this patient population.

Main Methods:

  • Retrospective review of medical records from The Mount Sinai Hospital (1970-1985).
  • Analysis of 57 episodes of CNS infections, including meningitis, brain abscesses, subdural empyema, and epidural abscess.
  • Evaluation of patient demographics, predisposing conditions, causative organisms, clinical presentation, and treatment outcomes.

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Main Results:

  • 57 CNS infection episodes were identified in patients aged 65+.
  • Streptococcus pneumoniae was the most common pathogen (43%), followed by gram-negative organisms (25%).
  • Fever (100%), altered mental status (86%), and meningismus (58%) were common presentations. Survival rate for meningitis was 65%, with mortality linked to altered mental status, delayed/inappropriate antibiotic therapy, and hypoglycorrhachia.

Conclusions:

  • Central nervous system infections in the elderly have a significant mortality rate, particularly meningitis.
  • Prompt and appropriate antibiotic therapy is critical for improving outcomes.
  • Focal CNS infections, unlike meningitis, demonstrated a high survival rate when presenting with localizing signs.