PRINCIPLES OF MANAGEMENT
In bacterial, mycobacterial, and fungal infections of
the CNS, prompt and aggressive an-timicrobial therapy is required. The duration
of treatment varies from as little as 10 days for uncomplicated bacterial
meningitis, to 12 months or longer for tuberculous meningi-tis, and to several
years for some cases of fungal meningitis.
In addition to antimicrobial therapy, correction of
associated metabolic defects (acido-sis, hypoxia, saline depletion, inappropriate
antidiuretic hormone secretion) is necessary. Increased intracranial pressure
as a result of vasogenic edema or hydrocephalus must be monitored and
controlled accordingly; osmotic agents such as intravenous mannitol are often
used to control acute cerebral edema, and neurosurgical shunting procedures may
be needed to treat progressive hydrocephalus. Abscesses often require drainage.
Except for those patients with herpes simplex encephalitis, who often respond
to early treatment with antiviral agents, most viral infections of the CNS can
only be managed supportively. This includes specific attention to the metabolic
and respiratory problems that may de-velop in severe cases.