Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminami-machi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan.
Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminami-machi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan.
Am J Emerg Med. 2022 Aug;58:120-125. doi: 10.1016/j.ajem.2022.05.055. Epub 2022 Jun 1.
Central nervous system (CNS) infections are often suspected in adult patients with fever-associated seizures. However, it is unclear whether lumbar puncture (LP) is routinely required in patients with fever-associated seizures. This study aimed to examine the prevalence of meningitis and encephalitis in adult patients with fever-associated seizures and to evaluate whether LP is routinely required.
We retrospectively studied patients aged ≥16 years who presented to the emergency department with complaints of seizures and fever above 37.5 °C who were admitted to the hospital between January 2017 and December 2019. LP was performed when the emergency physician suspected meningitis or encephalitis. Neurologists assessed patients with normal cerebrospinal fluid (CSF) findings and those admitted without LP after hospitalization. A neurologist confirmed the diagnoses of meningitis and encephalitis.
The study included 148 patients. Ninety-seven patients (65.5%) were male, and the median age was 60 years. LP was performed in 105 patients (70.9%), and 14 (13.4%) had CSF pleocytosis. Meningitis and encephalitis were diagnosed in nine patients (6.1%), of whom four (2.8%) had CNS infections. Patients diagnosed with meningitis and encephalitis were more likely to have Glasgow Coma Scale <13 (P = 0.03) and less likely to have a history of seizures or epilepsy (P = 0.04) and had higher C-reactive protein levels than the other patients (P = 0.02).
The prevalence of meningitis or encephalitis is relatively low in adult patients with fever-associated seizures. Lumbar puncture is considered unnecessary to be performed routinely, but its indication should be carefully considered with reference to the clinical course, comorbidities, and blood tests. Further validation studies with larger sample sizes are needed to confirm the findings of this study.
中枢神经系统（CNS）感染常被怀疑是发热伴发癫痫发作的成年患者的病因。然而，发热伴发癫痫发作患者是否常规需要腰椎穿刺（LP）尚不清楚。本研究旨在评估发热伴发癫痫发作的成年患者中脑膜炎和脑炎的患病率，并评估 LP 是否常规需要。
我们回顾性研究了 2017 年 1 月至 2019 年 12 月期间因发热（体温>37.5°C）伴发癫痫发作而到急诊科就诊并住院的年龄≥16 岁的患者。当急诊医师怀疑脑膜炎或脑炎时，进行 LP。神经科医生评估了脑脊液（CSF）正常的患者和住院期间未行 LP 而入院的患者。神经科医生确诊了脑膜炎和脑炎的诊断。
研究共纳入 148 例患者。97 例（65.5%）为男性，中位年龄为 60 岁。105 例行 LP（70.9%），14 例（13.4%）CSF 有白细胞增多。9 例（6.1%）诊断为脑膜炎和脑炎，其中 4 例（2.8%）有 CNS 感染。诊断为脑膜炎和脑炎的患者更可能格拉斯哥昏迷量表（Glasgow Coma Scale）<13（P=0.03），不太可能有癫痫发作或癫痫病史（P=0.04），且 C 反应蛋白水平高于其他患者（P=0.02）。
发热伴发癫痫发作的成年患者中脑膜炎或脑炎的患病率相对较低。LP 不被认为需要常规进行，但应根据临床过程、合并症和血液检查仔细考虑其适应证。需要进一步进行更大样本量的验证性研究来证实本研究的结果。
