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Neurologic infections can be classified by clinical syndrome/localization (e.g., meningitis vs encephalitis vs myelitis vs radiculitis) and by the type of infection (e.g., viral, bacterial, tuberculous, fungal, parasitic). This chapter is organized by clinical syndrome, with each section organized into subsections by the type of infection. At the end of the chapter, the neurologic manifestations of HIV/AIDS are discussed. Table 20–1 provides a summary of the most common types of clinical syndromes caused by each pathogen or group of pathogens.

TABLE 20–1Neurologic Syndromes Caused by Infections.


Meningitis (inflammation of the meninges) can be caused by:

  • Infection: most commonly bacterial, viral, fungal, or tuberculous; rarely parasitic

  • Immune-mediated: for example, sarcoidosis, rheumatoid arthritis, granulomatosis with polyangiitis (formerly called Wegener’s granulomatosis), IgG4-related disease, anti-GFAP astrocytopathy (meningoencephalitis or meningoencephalomyelitis; 25% have underlying neoplasm, most commonly ovarian teratoma), Vogt-Koyanagi-Harada (uveitis, vitiligo, alopecia, hearing loss)

  • Medications (chemical meningitis): nonsteroidal anti-inflammatory drugs (NSAIDs), intravenous immunoglobulin (IVIg), trimethoprim-sulfamethoxazole

  • Neoplasm: leptomeningeal metastases (also called carcinomatous meningitis), rupture of dermoid or epidermoid cyst, paraneoplastic (anti-GFAP, see above)

Most infectious meningeal processes predominantly affect the leptomeninges (arachnoid and pia), whereas most inflammatory processes predominantly affect the pachymeninges (dura mater), although there can be simultaneous involvement of both the pachymeninges and leptomeninges in both types of processes (see Fig. 2–10 and accompanying discussion “Contrast-enhanced Neuroimaging” in Ch. 2). Carcinomatous meningitis typically refers to leptomeningeal metastases (see “Leptomeningeal Metastases” in Ch. 24). Dural metastases also occur (most commonly with prostate and breast ...

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