Clinical Pathways
Clinical Pathways
Signs of intracranial infection
Signs of intracranial infection

Signs of intracranial infection

View The Full Pathway

Action

Obtain IV-contrast head CT or rapid-sequence MRI (Class II)

Decision

Abscess detected?

Yes

  • Perform frequent vital sign and neurologic checks
  • Elevate head of bed to 30° (Class II)
  • Consult neurosurgery and/or ENT
  • Administer broad-spectrum antibiotics (Class I)
  • Admit

No

  • Obtain lumbar puncture
  • Administer antibiotics (Class I)

Background

Initial Treatments

For any patient suspected of having an intracranial infection, after initial stabilization, it is imperative to start broad-spectrum IV antibiotics that can penetrate the blood-brain barrier; a delay in starting antibiotics is linked to increased morbidity and mortality.25^{25} For bacterial meningitis, the antibiotics of choice for neonates include ampicillin and cefepime (or ampicillin and gentamicin), which cover the most common causes of bacterial meningitis in neonates: GBS, E coli, and Listeria. Acyclovir should be added if there is concern for HSV meningitis, such as in neonates with known exposure or focal seizures, or in suspected cases of encephalitis.58^{58} In children aged >28 days, S pneumoniae is more common, so ceftriaxone plus vancomycin (to overcome penicillin-resistant pneumococci) is the initial treatment of choice. For empiric treatment of brain abscess, metronidazole is added for improved anaerobic bacteria coverage.25^{25} Surgical intervention for incision and drainage may also be needed to achieve proper source control.28^{28} Apart from varicella, HSV, and HIV, viral meningitis/encephalitis is typically treated with supportive care in an immunocompetent patient.26,29,59^{26,29,59}

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References
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