Infectious Etiologies of Altered Consciousness

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)201-216
Number of pages16
JournalHandbook of Clinical Neurology
Volume90
DOIs
StatePublished - 2008

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Consciousness
Acyclovir
Consciousness Disorders
Demyelinating Diseases
Adrenal Cortex Hormones
Viral Encephalitis
Foscarnet
Therapeutics
Meningeal Tuberculosis
Plasma Exchange
Doxycycline
Central Nervous System Diseases
Leukocytosis
Serologic Tests
Cephalosporins
Vancomycin
Communicable Diseases
Headache
Viruses
Glucose

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Infectious Etiologies of Altered Consciousness. / Roos, Karen.

In: Handbook of Clinical Neurology, Vol. 90, 2008, p. 201-216.

Research output: Contribution to journalArticle

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