Seizures in adults with suspected central nervous system infection

• Published in: BMC neurology Vol. 22; no. 1; pp. 1 - 426
• Main Authors: Olie, Sabine E, van Zeggeren, Ingeborg E, ter Horst, Liora, Citroen, J, van Geel, B. M, Heckenberg, S. G. B, Jellema, K, Kester, M. I, Killestein, J, Mook, B. B, Titulaer, M. J, van Veen, K. E. B, Verschuur, C. V. M
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 14.11.2022; BioMed Central; BMC
• Subjects: Accuracy; Antibiotics; Blood; Blood cell count; Care and treatment; Causes of; Central nervous system; Central nervous system diseases; Cerebrospinal fluid; CNS infection; Coma; Convulsions & seizures; Diabetes; Diagnosis; Diagnosis, Differential; Diagnostic accuracy; Diagnostic tests; Disseminated infection; Epilepsy; Etiology; Health aspects; Infections; Inflammatory diseases; Laboratories; Magnetic resonance imaging; Meningitis; Methods; Nervous system; Neurological diseases; Patients; Puncture; Risk factors; Seizures; Seizures (Medicine); Spine; Netherlands
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-022-02927-4

Abstract Background Seizures can be part of the clinical presentation of central nervous system (CNS) infections. We describe patients suspected of a neurological infection who present with a seizure and study diagnostic accuracy of clinical and laboratory features predictive of CNS infection in this population. Methods We analyzed all consecutive patients presenting with a seizure from two prospective Dutch cohort studies, in which patients were included who underwent cerebrospinal fluid (CSF) examination because of the suspicion of a CNS infection. Results Of 900 episodes of suspected CNS infection, 124 (14%) presented with a seizure. The median age in these 124 episodes was 60 years (IQR 45–71) and 53% of patients was female. CSF examination showed a leukocyte count ≥ 5/mm 3 in 41% of episodes. A CNS infection was diagnosed in 27 of 124 episodes (22%), a CNS inflammatory disorder in 8 (6%) episodes, a systemic infection in 10 (8%), other neurological disease in 77 (62%) and in 2 (2%) episodes another systemic disease was diagnosed. Diagnostic accuracy of clinical and laboratory characteristics for the diagnosis of CNS infection in this population was low. CSF leukocyte count was the best predictor for CNS infection in patients with suspected CNS infection presenting with a seizure (area under the curve 0.94, [95% CI 0.88 – 1.00]). Conclusions Clinical and laboratory features fail to distinguish CNS infections from other causes of seizures in patients with a suspected CNS infection. CSF leukocyte count is the best predictor for the diagnosis of CNS infection in this population.