Approach to Neurologic Infections

Aaron L. Berkowitz, MD, PhD Neuroinfectious Diseases p. 818-835 August 2021, Vol.27, No.4 doi: 10.1212/CON.0000000000000984
REVIEW ARTICLES
BROWSE ARTICLES
Article as PDF
-- Select an option --

PURPOSE OF REVIEW This article provides an overview of the clinical approach to the diagnosis of neurologic infections, focusing on the symptoms, signs, imaging features, and laboratory findings of the major categories of neuroinfectious diseases.

RECENT FINDINGS The increased use of immunosuppressive and immunomodulatory therapy to treat autoimmune diseases has led to an increase in opportunistic neurologic infections. The description of numerous causes of autoimmune antibody–mediated encephalitis over the past decade has expanded the differential diagnosis of encephalitis beyond infection. The emergence of metagenomic next-generation sequencing has led to diagnoses of rare or unexpected causes of neurologic infections and has the potential to enhance diagnostic precision in neuroinfectious diseases.

SUMMARY Infections of the nervous system can affect any level of the neuraxis and present over any time course. Neurologic infections may present atypically with respect to clinical, radiologic, and CSF analysis features in immunocompromised patients or older adults. A thorough evaluation including systemic features, past medical history, travel, exposures, detailed examination, neuroimaging, and CSF analysis is often necessary to make a definitive diagnosis. It is important to be aware of the test characteristics and limitations of microbiological tests on CSF for neurologic infections to avoid being misled by false positives or false negatives.

Address correspondence to Dr Aaron L. Berkowitz, Kaiser Permanente Bernard J. Tyson School of Medicine, 100 S Los Robles Ave, Pasadena, CA 91006, [email protected].

RELATIONSHIP DISCLOSURE: Dr Berkowitz serves on the editorial board for Continuum and has received publishing royalties from HarperCollins Publishers, McGraw Hill, MedMaster, and Oxford University Press.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Berkowitz reports no disclosure.

© 2021 American Academy of Neurology.