Neurological Syndromes and the Traveller: An Approach to Differential Diagnosis

Despite the large number of exotic infecting agents that may cause neurological syndromes, the returning traveller is more likely to be infected with an organism that is well known to the temperate physician. Meningitis will most likely be due to organisms indigenous to the UK, encephalitis will most likely be due to herpes simplex virus. The two most commonly imported life threatening tropical infections are malaria and typhoid, and these illnesses should be excluded quickly in all patients. Detailed history taking, particularly regarding travel, activities while away, sexual history and immunisation history helps to narrow the differential diagnosis. A methodical approach and basic knowledge of incubation periods can help to limit unnecessary investigation.