Central nervous system infections and their management in the Emergency Department

Abstract

The probability that a child has a central nervous system infection is a constant concern of the doctors in the emergency department. Clinical manifestations raising suspicion of CNS infection will depend on the patient's age, evolution time before being seen by the doctor, the etiologic agent and the specific disorder, among others. In infants, the association of impaired consciousness with irritability and drowsiness, fever, “bulging” fontanel, food rejection, seizures, petechiae and malaise are elements to consider. In older children, a history of fever associated with headaches, vomiting and stiff neck (meningeal syndrome) is frequently reported. The most important complementary test for diagnosis is the study of the cerebrospinal fluid, which can also suggest the probable outcome of the infection.