Treatment & Management

CNS infections
• Treatment based on underlying precipitating factors and presenting
signs and symptoms. Some diseases are treated immediately even
before investigation results are available.
• Corticosteroid are given together as anti-inflammatory and
immunosuppression.
• Surgical procedures must be done if necessary.
• Managements and precautious to improve health condition and
prevent recurrent attack.
Meningitis
• Acute bacterial meningitis-
• Antibiotic (1g i.v Cefotaxime, 1.2g s.i.v/i.m Benzylpenicillin, Penicillin,
Chloramphenicol)
• Steroids – Dexamethasone (to reduce inflammatory response towards
proinflammatory mediators release by dead bacteria)
• Surgical – paranasal sinus, depressed skull fracture or meningeal tear.
• Prophylaxis – immunization (Quadrivalent ACWY Meningococcal vaccines,
Polyvalent pneumococcal vaccine, Haemophilus influenza B vaccine) and
prophylaxis of contacts (rifampicin, ciprofloxacin).

• Viral Meningitis
• No specific treatments, unless encephalitis is present.
Chronic Meningitis
• Cryptococcal meningitis (Cryptococcosis)
• Antifungal drugs – Amphotericin B, flucystosine, fluconazole.
• Prophylaxis – cryptococcal antigen screening in HIV/Immunocompromised

• Tuberculous meningitis
• Antituberculosis agents. [next slide]

• Meningovascular Syphilis
• Antibiotics (Benzylpenicillin) and Steroids [next slide]
CNS Tuberculosis
Tuberculous meningitis, encephalopathy, radiculomyelitis, tuberculoma.
• 1st line Antituberculosis drugs – Streptomycin (S), Ethambutol (E), Rifampicin
(R), Isoniazid (H), Pyrazinamide (Z), (2-S/EHRZ+10-HR, 9-12 months).
[Ethambutol should be avoided due to its eye complication]
• Adjuvant corticosteroids – Dexamethasone (12-16mg/daily for 6weeks)
• 2nd line Antituberculosis drugs – ethionamide, cycloserine, ofloxacin, p-
aminosalicylic acid (PAS). [used in Multiple Drug Resistance - TB]
• Management – Directly Observed Therapy (DOT)
• Prevention – BCG vaccination, avoid TB-patients contact/ high risk area.
Syphilis
• Neurosyphilis, meningovascular syphilis, tabes dorsalis, Gen. paralysis
of the insane (GPI), congenital syphilis.
• Treatments – Benzylpenicillin 1 g/daily i.m for 10days in 1o syphilis
/doxycycline/ erythromycin, + steroids
• Prevention – normal, controlled, protective sex, contact tracing,
Cerebral Malaria
• Meningitis, encephalopathy
• Antimalarial drugs – Chloroquine, artemisin-based combination therapy (ACT),
Quinine + doxycycline, primaquine, artesunate (3/7days).
• Management: Intensive care facilities – mech. Ventilation, dialysis. Blood
transfusion.
• Prevention – prophylactic measures against mosquitoes (insect repellent, bed
nets, fogging), environmental cleanliness.
Leptospirosis
• Meningitis and encephalitis
• Antibiotics – Penicillin G, ampicillin, amoxicillin, doxycycline, cefotaxime, or
ceftriaxone. + corticosteroids.
• Management – dialysis, glucose and salt solution administration.
• Prevention – rats control, safe and clean drinking waters, avoid high risk area
such as waterfall, rivers, unhygienic food stalls.
Toxins mediated infection
• Botulism
• Treatments: antitoxin.
• Managements: Ventilation supports.

• Tetanus
• Treatments: human tetanus immunoglobulin + tetanus toxoid, tetanus toxoid
booster dose. benzodiazepines
• Preventions: immunization (tetanus vaccines)
Encephalitis
• Viral Encephalitis
• Anti-viral medications: Aciclovir 10mg/kg 3 times per day for 14-21 days
(treated immediately even before Ix results are available)
• Anti-retroviral therapy
• Anticonvulsants for seizures.
• Surgical treatments – decompressive craniectomy to prevent coning.
• Preventions – Immunization with viral vaccines (measles, mumps, rubella,
varicella, yellow fever, influenza, polio, Japanese encephalitis, chickenpox,
rabies, shingles, etc)