Viral meningoencephalitis: a review of diagnostic methods and guidelines for management
Identifieur interne : 000101 ( Psycho/Analysis ); précédent : 000100; suivant : 000102Viral meningoencephalitis: a review of diagnostic methods and guidelines for management
Auteurs : I. Steiner [Israël] ; H. Budka [Autriche] ; A. Chaudhuri [Royaume-Uni] ; M. Koskiniemi [Finlande] ; K. Sainio [Finlande] ; O. Salonen [Finlande] ; P. G. E. Kennedy [Royaume-Uni]Source :
- European Journal of Neurology [ 1351-5101 ] ; 2010-08.
English descriptors
- Teeft :
- Abnormality, Acute confusion, Acute encephalitis, Acyclovir, Acyclovir resistance, Acyclovir therapy, Adem, Adjunct treatment, Alternative diagnosis, Alternative possibilities, Antibody levels, Antigen detection, Antiretroviral therapy, Antiviral, Antiviral therapy, Appropriate tests, Arch neurol, Aspiration pneumonia, Basal ganglia, Beilinson campus, Blood cells, Brain biopsy, Brain function, Brain tissue, Broad spectrum, Cerebral infections, Cerebral involvement, Cerebrospinal, Chlamydia pneumoniae, Cingulate gyrus, Clin, Clin virol, Clinical course, Clinical features, Clinical manifestations, Clinical symptoms, Convincing class, Diagnostic accuracy class, Diagnostic investigations, Diagnostic measure, Early diagnosis, Efns, Efns european journal, Encephalitis, Encephalomyelitis, Enterovirus, Environmental factors, Etiology, Evidence level, Evidence scheme, Expert opinion, Familial hemiplegic migraine, Febrile disease, Focal abnormalities, Foscarnet, Ganciclovir, Good practice points, Gray matter, Hemorrhagic fever, Herpes, Herpes encephalitis, Herpes simplex encephalitis, Herpes simplex virus encephalitis, Hhv6 encephalitis, High dose dexamethasone, High dose steroids, High signal, Human herpesviruses, Imaging, Immune reconstitution syndrome, Immunocompetent, Immunocompetent children, Immunocompetent individuals, Immunosuppressed patients, Infection, Infectious agent, Infective, Intracranial pressure, Intrathecal antibody production, Japanese encephalitis, Journal compilation, Lancet, Lancet neurol, Lesion, Magn reson imaging, Magnetic resonance imaging, Matter hyperintensities, Medical management, Meningitis, Meningoencephalitis, Migraine, Mild mass, Multifocal, Multiple sclerosis, Multiplex polymerase chain reaction, Narrow spectrum, Ndings, Nervous system, Neurol, Neurol neurosurg psychiatry, Neurologic complications, Neurological, Neurological examination, Neurological sciences, Neurological signs, Neurology, Nipah virus, Nucleic, Nucleic acid, Nucleic acid detection, Other cases, Other infective causes, Outcome assessment, Overwhelming class, Paediatr neurol, Pathogen, Pediatric patients, Petach tiqva, Pleocytosis, Polymerase, Polymerase chain reaction, Preventive measures, Progressive multifocal leukoencephalopathy, Prospective study, Randomized, Representative population, Respiratory viruses, Retrospective study, Review articles, Serological tests, Simplex, Spinal cord, Steiner, Steroid, Steroid pulse therapy, Steroid therapy, Stool samples, Studies level, Subacute sclerosing panencephalitis, Surgical decompression, Syndrome, Systemic vasculitis, Therapeutic intervention, Therapeutic interventions, Vasculitis, Viral, Viral culture, Viral encephalitis, Viral infection, Viral infections, Viral meningitis, Viral meningoencephalitis, Virol, Virol methods, Virological tests, Virus encephalitis, Virus infection, Virus isolation, White matter.
Abstract
Background: Viral encephalitis is a medical emergency. The prognosis depends mainly on the pathogen and host immunologic state. Correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury. Methods: We searched the literature from 1966 to 2009. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear, we have stated our opinion as good practice points. Recommendations: Diagnosis should be based on medical history and examination followed by CSF analysis for protein and glucose levels, cellular analysis, and identification of the pathogen by polymerase chain reaction amplification (recommendation level A) and serology (level B). Neuroimaging, preferably by MRI, is essential (level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be performed immediately, LP should be delayed only under unusual circumstances. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. Patients must be hospitalized with easy access to intensive care units. Specific, evidence‐based, antiviral therapy, acyclovir, is available for herpes encephalitis (level A) and may also be effective for varicella‐zoster virus encephalitis. Ganciclovir and foscarnet can be given to treat cytomegalovirus encephalitis, and pleconaril for enterovirus encephalitis (IV class evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective, and their use is controversial, but this important issue is currently being evaluated in a large clinical trial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management.
Url:
DOI: 10.1111/j.1468-1331.2010.02970.x
Affiliations:
- Autriche, Finlande, Israël, Royaume-Uni
- Uusimaa, Vienne (Autriche)
- Helsinki, Vienne (Autriche)
- Université d'Helsinki
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virol</term><term>Clinical course</term><term>Clinical features</term><term>Clinical manifestations</term><term>Clinical symptoms</term><term>Convincing class</term><term>Diagnostic accuracy class</term><term>Diagnostic investigations</term><term>Diagnostic measure</term><term>Early diagnosis</term><term>Efns</term><term>Efns european journal</term><term>Encephalitis</term><term>Encephalomyelitis</term><term>Enterovirus</term><term>Environmental factors</term><term>Etiology</term><term>Evidence level</term><term>Evidence scheme</term><term>Expert opinion</term><term>Familial hemiplegic migraine</term><term>Febrile disease</term><term>Focal abnormalities</term><term>Foscarnet</term><term>Ganciclovir</term><term>Good practice points</term><term>Gray matter</term><term>Hemorrhagic fever</term><term>Herpes</term><term>Herpes encephalitis</term><term>Herpes simplex encephalitis</term><term>Herpes simplex virus encephalitis</term><term>Hhv6 encephalitis</term><term>High dose dexamethasone</term><term>High dose steroids</term><term>High signal</term><term>Human herpesviruses</term><term>Imaging</term><term>Immune reconstitution syndrome</term><term>Immunocompetent</term><term>Immunocompetent children</term><term>Immunocompetent individuals</term><term>Immunosuppressed patients</term><term>Infection</term><term>Infectious agent</term><term>Infective</term><term>Intracranial pressure</term><term>Intrathecal antibody production</term><term>Japanese encephalitis</term><term>Journal compilation</term><term>Lancet</term><term>Lancet neurol</term><term>Lesion</term><term>Magn reson imaging</term><term>Magnetic resonance imaging</term><term>Matter hyperintensities</term><term>Medical management</term><term>Meningitis</term><term>Meningoencephalitis</term><term>Migraine</term><term>Mild mass</term><term>Multifocal</term><term>Multiple sclerosis</term><term>Multiplex polymerase chain reaction</term><term>Narrow spectrum</term><term>Ndings</term><term>Nervous 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tests</term><term>Simplex</term><term>Spinal cord</term><term>Steiner</term><term>Steroid</term><term>Steroid pulse therapy</term><term>Steroid therapy</term><term>Stool samples</term><term>Studies level</term><term>Subacute sclerosing panencephalitis</term><term>Surgical decompression</term><term>Syndrome</term><term>Systemic vasculitis</term><term>Therapeutic intervention</term><term>Therapeutic interventions</term><term>Vasculitis</term><term>Viral</term><term>Viral culture</term><term>Viral encephalitis</term><term>Viral infection</term><term>Viral infections</term><term>Viral meningitis</term><term>Viral meningoencephalitis</term><term>Virol</term><term>Virol methods</term><term>Virological tests</term><term>Virus encephalitis</term><term>Virus infection</term><term>Virus isolation</term><term>White matter</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Viral encephalitis is a medical emergency. The prognosis depends mainly on the pathogen and host immunologic state. Correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury. Methods: We searched the literature from 1966 to 2009. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear, we have stated our opinion as good practice points. Recommendations: Diagnosis should be based on medical history and examination followed by CSF analysis for protein and glucose levels, cellular analysis, and identification of the pathogen by polymerase chain reaction amplification (recommendation level A) and serology (level B). Neuroimaging, preferably by MRI, is essential (level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be performed immediately, LP should be delayed only under unusual circumstances. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. Patients must be hospitalized with easy access to intensive care units. Specific, evidence‐based, antiviral therapy, acyclovir, is available for herpes encephalitis (level A) and may also be effective for varicella‐zoster virus encephalitis. Ganciclovir and foscarnet can be given to treat cytomegalovirus encephalitis, and pleconaril for enterovirus encephalitis (IV class evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective, and their use is controversial, but this important issue is currently being evaluated in a large clinical trial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management.</div></front></TEI><affiliations><list><country><li>Autriche</li><li>Finlande</li><li>Israël</li><li>Royaume-Uni</li></country><region><li>Uusimaa</li><li>Vienne (Autriche)</li></region><settlement><li>Helsinki</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université d'Helsinki</li></orgName></list><tree><country name="Israël"><noRegion><name sortKey="Steiner, I" sort="Steiner, I" uniqKey="Steiner I" first="I." last="Steiner">I. Steiner</name></noRegion></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Budka, H" sort="Budka, H" uniqKey="Budka H" first="H." last="Budka">H. Budka</name></region></country><country name="Royaume-Uni"><noRegion><name sortKey="Chaudhuri, A" sort="Chaudhuri, A" uniqKey="Chaudhuri A" first="A." last="Chaudhuri">A. Chaudhuri</name></noRegion><name sortKey="Kennedy, P G E" sort="Kennedy, P G E" uniqKey="Kennedy P" first="P. G. E" last="Kennedy">P. G. E. Kennedy</name></country><country name="Finlande"><region name="Uusimaa"><name sortKey="Koskiniemi, M" sort="Koskiniemi, M" uniqKey="Koskiniemi M" first="M." last="Koskiniemi">M. Koskiniemi</name></region><name sortKey="Sainio, K" sort="Sainio, K" uniqKey="Sainio K" first="K." last="Sainio">K. Sainio</name><name sortKey="Salonen, O" sort="Salonen, O" uniqKey="Salonen O" first="O." last="Salonen">O. Salonen</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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