Meningitis

CNS infection should be considered in all patients with a headache, neck stiffness, fever, altered sensorium, or diffuse or focal neurological findings.
pneumoniae is one of the two leading causes of bacterial meningitis in adults. Mortality from S. pneumoniae is 30%.
pay close attention to cranial nerves 2, 3, 4, and 6
Altered mental status in a patient with suspected meningitis can be a sign of increased ICP or encephalitis.
You’ve got to get the LP! Only true way to assess for meningitis
Early initiation of empirical antimicrobial therapy is recommended in cases of suspected acute CNS infection. Antibiotic administration should not be delayed for CSF analysis or performance of neuroimaging studies.
Antibiotic chemoprophylaxis should be assured for close contacts of patients with meningitis resulting from N. meningitidis or H. in uenza.
Concomitant CNS infection should be strongly considered in any symptomatic patient with another severe systemic infection, such as urinary tract infection or pneumonia.
First line treatment for bacterial meningitis is ceftriaxone plus vancomycin.
Acyclovir is recommended for patients with suspected meningoencephalitis.
Dexamethasone is recommended prior to treatment with antibiotics in adults (controversial)