A disorder of consciousness may be due to any of a number of infectious diseases. Table 11.4 summarizes the recommended serological tests and Table 11.5 the recommended CSF diagnostic studies to determine an infectious etiology for the patient's altered consciousness. Often empiric therapy with a combination of a third- or fourth-generation cephalosporin, vancomycin, acyclovir, and doxycycline is initiated while awaiting the results of the spinal fluid analysis. In the patient with suspected viral encephalitis in whom a specific virus cannot be identified, empiric therapy with acyclovir, or foscarnet if the patient fails to respond to acyclovir, is reasonable. Empiric therapy for tuberculous meningitis should be initiated in the patient with a history of a headache of longer than 4 weeks' duration and now an altered level of consciousness, and a spinal fluid lymphocytic pleocytosis with a mildly decreased glucose concentration until another etiology can be determined. In the patient with altered consciousness with evidence of an inflammatory, demyelinating CNS disease, high-dose intravenous corticosteroid therapy should be given with a course of acyclovir for VZV infection as this may present as a demyelinating disorder. If the patient fails to improve on high-dose intravenous corticosteroid therapy, a course of plasma exchange is recommended.
ASJC Scopus subject areas
- Clinical Neurology