Seizures in adults with suspected central nervous system infection

Sabine E. Olie, Ingeborg E. van Zeggeren, I.-PACE Study Group, Liora ter Horst, Diederik van de Beek, Matthijs C. Brouwer*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
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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/mm3 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.

Original languageEnglish
Article number426
JournalBMC Neurology
Issue number1
Publication statusPublished - 14 Nov 2022

Bibliographical note

Funding Information:
This work was supported by the Netherlands Organization for Health Research and Development (ZonMw; NWO-Vidi Grant [grant number 917.17.308] and the European Research Council (ERC consolidator grant [grant number 101001237] to M.B.).

Publisher Copyright:
© 2022, The Author(s).


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