AANN Core Curriculum, 7th Edition, Ch. 13 CNS Infections and Multiple Sclerosis: Digital Version-Chapter 13

Chapter 13

Pdf Summary

The chapter reviews major central nervous system (CNS) infections and multiple sclerosis (MS), emphasizing that suspected CNS infection can be life-threatening and often requires urgent assessment and treatment.<br /><br />Meningitis inflames the protective membranes around the brain and spinal cord. Bacterial meningitis can progress rapidly; fever, headache, neck stiffness, and altered mental status warrant immediate empiric antibiotics, without delaying treatment for lumbar puncture. Cultures, cerebrospinal fluid (CSF) analysis, PCR, and imaging help identify the cause and complications. Vaccination and, for close contacts of some infections, antibiotic prophylaxis help prevent disease. Viral meningitis is usually milder and self-limiting, while fungal and tuberculous meningitis are often more prolonged and especially dangerous for immunocompromised people.<br /><br />Encephalitis involves brain tissue and can cause altered mental status, fever, seizures, and focal deficits. Because herpes simplex encephalitis is severe but treatable, early intravenous acyclovir is critical when suspected. Other infections discussed include arboviral encephalitis, Lyme neuroborreliosis, neurocysticercosis, herpes zoster, and infections caused by EBV or CMV. The chapter also covers rapidly progressive, fatal Creutzfeldt–Jakob disease; HIV-related cognitive and peripheral nerve disorders; and infections such as brain abscess, empyema, spinal epidural abscess, and ventriculitis. Diagnosis and management vary by cause, but commonly involve laboratory testing, CSF studies and imaging, targeted antimicrobials, supportive care, and sometimes surgical drainage or decompression.<br /><br />MS is a chronic immune-mediated CNS disease involving inflammation, myelin loss, and axonal injury. Its course may involve relapses and remissions or gradual progression. Symptoms include visual impairment, fatigue, sensory changes, weakness, spasticity, bladder problems, cognitive difficulties, and mood changes. Diagnosis relies on clinical findings and MRI evidence of lesions separated in space and time, with CSF testing sometimes providing support. Treatment includes disease-modifying therapies, short courses of corticosteroids for relapses, and individualized symptom management, rehabilitation, exercise, and psychosocial support.

Keywords

central nervous system infections

meningitis

encephalitis

multiple sclerosis

bacterial meningitis

herpes simplex encephalitis

cerebrospinal fluid analysis

lumbar puncture

antimicrobial treatment

MRI diagnosis