The literature on neurologic complications of infection by Bacillus anthacis is reviewed at the Dent Neurologic Institute, Buffalo, NY. The major neurologic complication is a rapidly fatal hemorrhagic meningoencephalitis. The initial mode of entry of the bacillus is via the cutaneous or inhalation route. One of the earliest cases of hemorrhagic meningoencephalitis from anthrax, in a boy aged 15 years, was characterized by numerous focal bleeds in the surface grey matter but very few hemorrhages in the white matter . House also reported autopsies on 2 adults with anthrax-related hemorrhagic meningitis, contracted in a Chicago factory by handling “curled hair” from South America. Other cases have involved contaminated heroin from Afghanistan, Pakistan, and Iran, in drug users, contaminated beef in slaughter house workers, and contact with sheep in farmers. CSF findings in 2 children with anthrax meningitis showed low glucose, increased protein and leucocytes, and large gram-positive rods without endospores on gram stain. CT scan shows multifocal areas of intracerebral hemorrhage. Inhalation cases of anthrax meningoencephalitis, affecting half the cases autopsied in the Russian 1979 outbreak, are particularly severe. In a recent report of fatal inhalation anthrax due to bioterrorism, the patient developed a generalized seizure within hours of admission and died on the third hospital day . Death usually occurs within a week in cases of anthrax with neurologic involvement. Further research is needed to develop more rapid PCR methods to detect the disease in suspected cases. Antibiotic treatment with ciprofloxacin or doxycycline must be started immediately when the diagnosis is first apparent. 
COMMENT. Anthrax should be considered in the differential diagnosis in a patient with fever, dark necrotic pustules on the extremities, acute neurologic deterioration, gram-positive rods in the CSF, and multifocal intracerebral hemorrhages on CT.