Last reviewed: June 2018
Last updated: July  2017



History and exam

Key diagnostic factors

  • male gender
  • age <30 years
  • meningismus
  • headache
  • cranial nerve palsy
  • positive Kernig or Brudzinski sign
  • fever
  • increased head circumference (infants)
  • bulging fontanelles (infants)

Other diagnostic factors

  • neurological deficit
  • papilledema

Risk factors

  • sinusitis
  • otitis media
  • dental procedure/infection
  • meningitis
  • recent neurosurgery
  • congenital heart disease
  • endocarditis
  • diverticular disease
  • hereditary hemorrhagic telangiectasia or AVM
  • diabetes mellitus
  • HIV or immunocompromise
  • IV drug use
  • chronic granulomatous disease
  • hemodialysis
  • birth prematurity
  • cystic fibrosis

Diagnostic investigations

1st investigations to order

  • CBC
  • serum ESR
  • serum CRP
  • serum PT and PTT
  • blood culture
  • serum toxoplasma titer
  • MRI with contrast
  • CT head with and without contrast
  • ultrasound head (infants)
Full details

Investigations to consider

  • magnetic resonance spectroscopy (MRS)
  • LP with CSF analysis
  • CT chest, abdomen, and pelvis
  • bone scan
  • mammogram
Full details

Treatment algorithm


Authors VIEW ALL


Department of Neurosurgery

SUNY Upstate Medical University




WAH is an author of a number of references cited in this monograph.

Dr Walter A. Hall would like to gratefully acknowledge Dr Peter D. Kim, a previous contributor to this monograph. PDK declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor and Head

Department of Neurosurgery

University of Minnesota




SH and WAH were colleagues on a faculty of the University of Minnesota between 1991 and 1997 and again between 2004 and 2006. They have coauthored articles on neurosurgical infection.

Staff Physician

Department of Neurological Sciences

Institute of Neurology C. Mondino




SR declares that she has no competing interests.

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