In what is believed to be the first formal "census" of
neurological diseases and their impact,
Johns Hopkins researchers have found that brain and nervous
system infections are more difficult to
diagnose and treat and have a remarkably higher rate of
morbidity and mortality compared to other
neurological problems.
Researchers have long known that patients with
neurological infections, such as encephalitis,
meningitis or West Nile disease, represent a significant
health care burden because identifying the
culprit bacterium, virus or fungus in their blood or
tissues is challenging and because treatments often
require patients to endure extended and expensive
hospitalizations. Patients with probable
neurological infections are often subjected to extensive
and costly rounds of diagnostic tests, long-
term prognosis may be grim, and lengthy rehabilitation or
nursing home stays are typical among
survivors.
But no formal tally of the extent of the demand and
need for care, along with the challenges
they pose for a major medical center, had been made, said
Avindra Nath, professor of neurology and
director of the Division of
Neuroimmunology and Neurological Infections at the
Johns Hopkins University School of Medicine.
In Nath's study, published in the Oct. 7 issue of
Neurology, he and his colleagues report the
result of combing through the records of 4,225 patients
admitted to either The Johns Hopkins
Hospital or Johns Hopkins Bayview Medical Center between
October 2004 and December 2005 and
seen by a neurologist for any reason.
Among 116 of these patients who were ultimately
diagnosed with neurological infections, doctors
were able to identify the organisms that caused them in 80,
while for 36, the diagnosis and treatment
had to depend solely on symptoms when no organism could be
found.
Regardless of how they were diagnosed, almost half the
patients stayed in the hospital longer
than two weeks, and 28 percent required rehabilitation or
were debilitated enough to require a long-
term-care facility, compared to about 19 percent of all
patients admitted to Johns Hopkins' neurology
service during the same time period.
About 12 percent of patients with neurological
infections died of their illnesses in the hospital,
compared to about 3 percent of all Johns Hopkins' neurology
patients.
"We now have numbers to confirm what neurologists have
suspected all along," Nath said.
"There is a tremendous morbidity and mortality burden for
these patients, and there are serious
challenges for hospitals to treat and manage the
problems."
Having the data, Nath said, should help medical
specialists set priorities for providing resources
and research to enable faster diagnosis and quicker
treatments, factors known to improve long-term
outcomes. Establishing a tissue bank to store samples from
patients who don't receive a definitive
diagnosis may help researchers eventually develop new
diagnostic tests, Nath said.