Infections of the Nervous System

  • Larry E. DavisEmail author
  • Sarah Pirio Richardson


The chapter begins with a discussion of common major clinical features and mechanisms of damage produced by infections of the central nervous system (CNS). Viruses, bacteria, fungi, and parasites cause CNS infections. Most organisms reach the central nervous system via the blood stream after entering the body via the gastrointestinal tract, respiratory tract, or following skin inoculation (animal or insect bites). The CNS evolved differently from other systemic organs and did not develop a sensitive immune surveillance system. Instead, a blood–brain barrier evolved to prevent infectious organisms from entering the CNS. Unfortunately, if an infectious organism successfully enters the CNS, there are limited defenses to fight the infection. The signs and symptoms of a CNS infection depend on the site of the infection and not the infectious organism. Major sites of infections are diffusely in the meninges (meningitis), diffusely in the brain (encephalitis), and focally in the brain (abscess). The organism determines the time course and severity of the infection. This chapter then discusses major types of central and peripheral nervous system infections: bacterial and viral meningitis, brain abscess, encephalitis, prion Creutzfeldt–Jakob disease, herpes zoster or shingles, and paraneoplastic limbic encephalitis that mimics encephalitis. Attention is paid to their pathophysiology, major clinical features, major laboratory findings, and principles of management and prognosis.


Blood–brain barrier Bacterial meningitis Viral meningitis Brain abscess Encephalitis Herpes simplex virus West Nile virus Prion Creutzfeldt–Jakob disease Anti-NMDAR limbic encephalitis Varicella virus Acyclovir 

Recommended Reading

  1. Ziai WC, Lewin JJ. Update in the diagnosis and management of central nervous system infections. Neurol Clin. 2008;26:427–68. (Reviews current concepts of the major CNS infections).PubMedCrossRefGoogle Scholar
  2. Logan SAE, MacMahon E. Viral meningitis. Brit Med J. 2008;336:36–40. (Good review of the many causes of viral meningitis).PubMedCentralPubMedCrossRefGoogle Scholar
  3. Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis. 2010;10:32–42. (Excellent review of pathogenesis, characteristics, diagnosis, and management of bacterial meningitis).PubMedCrossRefGoogle Scholar
  4. Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antiviral Res. 2006;71:141–8. (Good review of diagnosis, pathology, and management of HSE).PubMedCrossRefGoogle Scholar
  5. Davis LE, Beckham JD, Tyler KL. North American encephalitic arboviruses. Neurol Clin. 2008;26:727–57. (Reviews all major arbovirus encephalitis viruses that cause infections in the USA).PubMedCentralPubMedCrossRefGoogle Scholar
  6. Schmader, K. Herpes zoster and postherpetic neuralgia in older adults. Clin Geriatr Med. 2007;23:615–32. (Good review of epidemiology, clinical, diagnosis, and management of shingles and postherpetic neuralgia).PubMedCrossRefGoogle Scholar
  7. Brown P. Transmissible spongiform encephalopathy in the 21st century. Neuroscience for the clinical neurologist. Neurology. 2008;70:713–22. (Excellent review of progress in understanding prions).PubMedCrossRefGoogle Scholar
  8. Rosenfeld MR, Dalmau J. Update on paraneoplastic neurologic disorders. The Oncologist. 2010;15:603–17. (Excellent review of the types, clinical features, workups, and management of paraneoplastic syndromes).PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2015

Authors and Affiliations

  1. 1.Chief Neurology ServiceDistinguished Professor of Neurology New Mexico VA Health Care SystemAlbuquerqueUSA
  2. 2.Department of Neurology Health Sciences CenterUniversity of New MexicoAlbuquerqueUSA

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