Brain, Spine & Nerves · ICU Decoded chapter 33 · Free in full
Cited to IDSA / ESCMID guidelines.
Key points
When meningitis is suspected → blood cultures + ceftriaxone 2 g q12h + vancomycin NOW; never let LP delay antibiotics.
Age >50 or immunocompromise calls for added ampicillin (Listeria); dexamethasone 10 mg q6h goes with or before the first antibiotic dose (pneumococcal).
Fever with focal signs or seizures is HSV encephalitis until excluded: start aciclovir 10 mg/kg q8h and send LP HSV PCR.
Brain abscess: MRI, neurosurgery, ceftriaxone/metronidazole (dental source); don't LP with mass effect.
Pathways
Initial Evaluation of Possible Central Nervous System (CNS) Infection
Does the clinical picture fit CNS infection?
Any indication for imaging? (history of CNS disease · recent seizure · altered level of consciousness · new focal neurologic deficits · neurologic deficits with immunosuppression)
Blood cultures plus empirical antibiotics ± steroids → PERFORM IMAGING
Imaging shows contraindication to lumbar puncture?
Treat on without lumbar puncture
Lumbar puncture
Blood cultures plus lumbar puncture → empirical antibiotics ± steroids
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.