Fitch Michael T, Abrahamian Fredrick M, Moran Gregory J, Talan David A
Department of Emergency Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Infect Dis Clin North Am. 2008 Mar;22(1):33-52, v-vi. doi: 10.1016/j.idc.2007.10.001.
Bacterial meningitis and viral encephalitis are infectious disease emergencies that can cause significant patient morbidity and mortality. Clinicians use epidemiologic, historical, and physical examination findings to identify patients at risk for these infections, and central nervous system (CNS) imaging and lumbar puncture (LP) may be needed to further evaluate for these diagnoses. The diagnosis of bacterial meningitis can be challenging, as patients often lack some of the characteristic findings of this disease with presentations that overlap with more common disorders seen in the emergency department. This article addresses considerations in clinical evaluation, need for CNS imaging before LP, interpretation of cerebrospinal fluid results, standards for and effects of timely antibiotic administration, and recommendations for specific antimicrobial therapy and corticosteroids.
细菌性脑膜炎和病毒性脑炎是可导致患者出现严重发病和死亡情况的感染性疾病急症。临床医生利用流行病学、病史及体格检查结果来识别有这些感染风险的患者，可能需要进行中枢神经系统（CNS）影像学检查和腰椎穿刺（LP）以进一步评估这些诊断。细菌性脑膜炎的诊断可能具有挑战性，因为患者常常缺乏该疾病的一些特征性表现，其症状与急诊科中更常见疾病的症状相互重叠。本文探讨了临床评估中的注意事项、腰椎穿刺前进行中枢神经系统影像学检查的必要性、脑脊液检查结果的解读、及时使用抗生素的标准及效果，以及针对特定抗菌治疗和皮质类固醇的建议。
