Table 1.
Summary of Potential Neuroterrorism Agents and Their Potential Neurologic Manifestations, Diagnostic Methods, and Treatments.
| Agent | Potential Neurologic Manifestations | Diagnostic Methods | Treatment |
|---|---|---|---|
| Biologic agents | |||
| Anthrax | Hemorrhagic meningoencephalitis | Clinical presentation and exposure history; bacterial culture; detection of nucleic acid, toxins, or antibodies | TX: Fluoroquinolones and other antibiotics, antitoxin PPX: Fluoroquinolones and other antibiotics, vaccination |
| Botulism | Descending flaccid paralysis, autonomic dysfunction | Clinical presentation and exposure history; mouse bioassay; detection of neurotoxin | Botulinum antitoxin or immunoglobulin, respiratory support |
| Brucellosis | Acute: Meningitis, meningoencephalitis Chronic: Peripheral neuropathy, radiculopathy, or cranial nerve palsies. | Clinical presentation and exposure history; bacterial culture; detection of antibodies | Doxycycline and other antibiotics |
| Plague | Meningoencephalitis | Clinical presentation and exposure history; gram stain; bacterial culture; detection of nucleic acid or antibodies | TX: Fluoroquinolones and other antibiotics PPX: Fluoroquinolones and other antibiotics |
| Smallpox | Meningoencephalitis | Clinical presentation and exposure history; viral isolation; detection of nucleic acid | TX: Vaccinia immune globulin intravenous (VIGIV), tecovirimat/ST-246, or cidofovir PPX: Vaccination |
| Chemical agents | |||
| Organophosphates and nerve agents | Acute: Muscarinic and nicotinic neurologic effects (Table 2), seizures Chronic: Intermediate syndrome |
Clinical presentation and exposure history | Atropine, 2-PAM, benzodiazepines for seizures, respiratory support |
| Cyanide | Acute: CNS depression, seizures, coma Chronic: Parkinsonism |
Clinical presentation and exposure history; elevated anion gap and lactate level | Hydroxocobalamin (vitamin B12a), amyl and sodium nitrite, sodium thiosulfate |
| Carfentanil | CNS and respiratory repression | Clinical presentation and exposure history; specific drug assays | Naloxone, respiratory support |
Abbreviations: CNS, central nervous system; CSF, cerebrospinal fluid; PPX, prophylaxis; TX, treatment; 2-PAM, 2-pyridine aldoxime methyl chloride.