Bacterial meningitis and brain abscess

Central nervous system infections are associated with a high mortality and morbidity in all population groups. Early diagnosis and treatment of bacterial meningitis and brain abscess leads to improved outcomes. Suspected bacterial meningitis should be considered a medical emergency with an emphasis on early lumbar puncture and prompt initiation of empirical antibiotic therapy together with corticosteroids. The indications for neuroimaging before lumbar puncture are limited, and recently published guidelines should help to discourage unnecessary scans. Conversely, timely diagnosis of brain abscess requires a high index of suspicion and early cerebral imaging. Management requires good cooperation between emergency physicians, radiologists, infection specialists and neurosurgeons to optimize outcomes.