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Updated: Oct 26, 2026

Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Detection of Central Nervous System Pathogens
Published on: April 17, 2026
Meningitis, encephalitis, and beyond: A practical intensive care unit guide to severe central nervous system
Katharina M Busl1, Nate Ordway2, Romain Sonneville3
1Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA.
Abstract:
Infections of the central nervous system can require immediate admission to an intensive care unit (ICU) because of initial severe neurologic presentation or systemic complications or may be encountered during the course of a hospital stay because of secondary complications. Brain infections include community-acquired or healthcare-associated meningitis, ventriculitis, encephalitis, and brain abscesses, which share specific clinical features but have different pathophysiology, risk factors, and outcomes. In this review, we will provide a practice-based overview of severe presentations of brain infections as encountered by the intensivist, focusing on early decision-making, the sequence of diagnostic and management decisions, and encountered complications. We illustrate the review with case examples to offer real-life illustrations of challenging decision-points. Key take-home points include understanding the first-hour priorities for de novo presentation of meningitis and encephalitis with a focus on early initiation of antimicrobial treatment; awareness of limitations in cerebrospinal fluid (CSF)-based diagnostics for early encephalitis and in healthcare-associated meningitis and ventriculitis, and the importance of an expedited, non-CSF-based diagnostic approach to brain abscesses.
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