Skip to main content

Advertisement

SpringerLink
Log in

Infection–associated encephalopathies—their investigation, diagnosis, and treatment

  • REVIEW
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Reduced level of consciousness is a common clinical finding in acutely sick patients. In the majority of cases a cause for the encephalopathy is readily identifiable,whilst in a minority the aetiology is more difficult to ascertain.

Frequently the onset of encephalopathy is associated with, or follows, infection. The mechanisms through which infection leads to encephalopathy are diverse. They range from direct microbial invasion of the brain or its supporting structures, to remote, infectiontriggered mechanisms such as acute disseminated encephalomyelitis. Most common however, is the encephalopathy caused through a remote effect of systemic sepsis—septic encephalopathy.

This article discusses the clinical presentation and underlying pathogeneses of the acute encephalopathies associated with infection, aiming to aid both their recognition and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ADEM:

acute disseminated encephalomyelitis

AHLE:

acute haemorrhagic leukoencephalopathy

AIE:

acute infectious encephalitis

ATE:

acute toxic encephalopathy

CMV:

cytomegalovirus

CNS:

central nervous system

CSF:

cerebrospinal fluid

EBV:

Epstein Barr virus

EEG:

electroencephalogram

HSE:

herpes simplex encephalitis

HSV:

herpes simplex virus

JEV:

Japanese encephalitis virus

PCR:

polymerase chain reaction

PNS:

peripheral nervous system

PLEDS:

periodic lateralised epileptiform discharges

SE:

septic encephalopathy

UK:

United Kingdom

USA:

United States of America

WNV:

West Nile Virus

References

  1. Case notifications ofWest Nile virus neuroinvasive disease and death in the United States of America during 2003. http://www. cdc. gov/ncidod/dvbib/west nile/survandcontrolCaseCount03_ detailed. htm. 15–6–2004

  2. Valacyclovir for longterm therapy of Herpes simplex encephalitis. http://clinicaltrials. gov/ct/show/NCT0 0031486?order = 1. 2004

  3. Archer H, Wall R (2003) Acute haemorrhagic leukoencephalopathy: two case reports and review of the literature. J Infect 46:133–137

    Article  PubMed  CAS  Google Scholar 

  4. Aurelius E, Johansson B, Skoldenberg B, Staland A, Forsgren M (1991) Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid. Lancet 337:189–192

    Article  PubMed  CAS  Google Scholar 

  5. Autret–Leca E, Jonville–Bera AP, Llau ME, Bavoux F, Saudubray JM, Laugier J, Devictor D, Barbier P (2001) Incidence of Reye’s syndrome in France: a hospital– based survey. J Clin Epidemiol 54:857–862

    Article  PubMed  CAS  Google Scholar 

  6. Ben Nathan D, Lustig S, Tam G, Robinzon S, Segal S, Rager–Zisman B (2003) Prophylactic and therapeutic efficacy of human intravenous immunoglobulin in treating West Nile virus infection in mice. J Infect Dis 188:5–12

    Article  PubMed  CAS  Google Scholar 

  7. Bleck TP, Smith MC, Pierre–Louis SJ, Jares JJ, Murray J, Hansen CA (1993) Neurologic complications of critical medical illnesses. Crit Care Med 21:98–103

    PubMed  CAS  Google Scholar 

  8. Bolton CF, Young GB, Zochodne DW (1993) The neurological complications of sepsis. Ann Neurol 33:94–100

    Article  PubMed  CAS  Google Scholar 

  9. Booss J, Davis LE (2003) Smallpox and smallpox vaccination: Neurological implications. Neurology 60:1241–1245

    PubMed  Google Scholar 

  10. Brick JF, Brick JE, Morgan JJ, Gutierrez AR (1990) EEG and pathologic findings in patients undergoing brain biopsy for suspected encephalitis. Electroencephalogr Clin Neurophysiol 76:86–89

    Article  PubMed  CAS  Google Scholar 

  11. Cartmell T, Luheshi GN, Rothwell NJ (1999) Brain sites of action of endogenous interleukin–1 in the febrile response to localized inflammation in the rat. J Physiol 518(Pt 2):585–594

    Article  PubMed  CAS  Google Scholar 

  12. Chadwick J, Mann WN (1950) Epidemics, Book III. The medical works of Hippocrates. Blackwell Scientific Publications, Oxford, p 65

  13. Chataway J, Davies NW, Farmer S, Howard RS, Thompson EJ, Ward KN (2004) Herpes simplex encephalitis: an audit of the use of laboratory diagnostic tests. QJM 97:325–330

    Article  PubMed  CAS  Google Scholar 

  14. Chowers MY, Lang R, Nassar F, Ben David D, Giladi M, Rubinshtein E, Itzhaki A, Mishal J, Siegman–Igra Y, Kitzes R, Pick N, Landau Z, Wolf D, Bin H, Mendelson E, Pitlik SD, Weinberger M (2001) Clinical characteristics of the West Nile fever outbreak, Israel, 2000. Emerg Infect Dis 7:675–678

    Article  PubMed  CAS  Google Scholar 

  15. Cinque P, Cleator GM, Weber T, Monteyne P, Sindic CJ, van Loon AM (1996) The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report. The EU Concerted Action on Virus Meningitis and Encephalitis. J Neurol Neurosurg Psychiatry 61:339–345

    PubMed  CAS  Google Scholar 

  16. Combrinck MI, Perry VH, Cunningham C (2002) Peripheral infection evokes exaggerated sickness behaviour in pre–clinical murine prion disease. Neuroscience 112:7–11

    Article  PubMed  CAS  Google Scholar 

  17. Dafny N, Prieto–Gomez B, Dong WQ, Reyes–Vazquez C (1996) Interferon modulates neuronal activity recorded from the hypothalamus, thalamus, hippocampus, amygdala and the somatosensory cortex. Brain Res 734:269–274

    Article  PubMed  CAS  Google Scholar 

  18. Dale RC, Church AJ, Cardoso F, Goddard E, Cox TC, Chong WK, Williams A, Klein NJ, Neville BG, Thompson EJ, Giovannoni G (2001) Poststreptococcal acute disseminated encephalomyelitis with basal ganglia involvement and auto–reactive antibasal ganglia antibodies. Ann Neurol 50:588–595

    Article  PubMed  CAS  Google Scholar 

  19. Dale RC, de Sousa C, Chong WK, Cox TC, Harding B, Neville BG (2000) Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. Brain 123(Pt 12):2407–2422

    Article  PubMed  Google Scholar 

  20. Dantzer R (2001) Cytokine–induced sickness behavior: mechanisms and implications. Ann N Y Acad Sci 933:222–234

    Article  PubMed  CAS  Google Scholar 

  21. Davies DC, Parmar NK, Moss R, Tighe D, Bennett ED (2001) The role of the adrenergic system in septic encephalopathy. Critical Care 5:S83–S84

    Article  Google Scholar 

  22. Davison KL, Crowcroft NS, Ramsay ME, Brown DW, Andrews NJ (2003) Viral encephalitis in England, 1989–1998: what did we miss? Emerg Infect Dis 9:234–240

    PubMed  Google Scholar 

  23. De Marcaida JA, Reik L Jr (1999) Disorders that mimic central nervous system infections. Neurol Clin 17:901–941

    Article  PubMed  CAS  Google Scholar 

  24. Dennett C, Cleator GM, Klapper PE (1997) HSV–1 and HSV–2 in herpes simplex encephalitis: a study of sixtyfour cases in the United Kingdom. J Med Virol 53:1–3

    Article  PubMed  CAS  Google Scholar 

  25. Eidelman LA, Putterman D, Putterman C, Sprung CL (1996) The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities. JAMA 275:470–473

    Article  PubMed  CAS  Google Scholar 

  26. Fisher RS, Clark AW, Wolinsky JS, Parhad IM, Moses H, Mardiney MR (1983) Postinfectious leukoencephalitis complicating Mycoplasma pneumoniae infection. Arch Neurol 40:109–113

    PubMed  CAS  Google Scholar 

  27. Fodor PA, Levin MJ, Weinberg A, Sandberg E, Sylman J, Tyler KL (1998) Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF. Neurology 51:554–559

    PubMed  CAS  Google Scholar 

  28. Garg RK (2003) Acute disseminated encephalomyelitis. Postgrad Med J 79:11–17

    Article  PubMed  CAS  Google Scholar 

  29. Gilden DH, Kleinschmidt–DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ (2000) Neurologic complications of the reactivation of varicellazoster virus. N Engl J Med 342:635–645

    Article  PubMed  CAS  Google Scholar 

  30. Ginsberg L, Compston DA (1994) Acute encephalopathy: diagnosis and outcome in patients at a regional neurological unit. Q J Med 87:169–180

    PubMed  CAS  Google Scholar 

  31. Glasgow JF, Moore R (1993) Current concepts in Reye’s syndrome. Br J Hosp Med 50:599–604

    PubMed  CAS  Google Scholar 

  32. Gordon B, Selnes OA, Hart J Jr, Hanley DF, Whitley RJ (1990) Long–term cognitive sequelae of acyclovir–treated herpes simplex encephalitis. Arch Neurol 47:646–647

    PubMed  CAS  Google Scholar 

  33. Hart MN, Earle KM (1975) Haemorrhagic and perivenous encephalitis: a clinical–pathological review of 38 cases. J Neurol Neurosurg Psychiatry 38:585–591

    Article  PubMed  CAS  Google Scholar 

  34. Heiner L, Demaerel P (2003) Diffusion– weighted MR imaging findings in a patient with herpes simplex encephalitis. Eur J Radiol 45:195–198

    Article  PubMed  CAS  Google Scholar 

  35. Hindmarsh T, Lindqvist M, Olding– Stenkvist E, Skoldenberg B, Forsgren M (1986) Accuracy of computed tomography in the diagnosis of herpes simplex encephalitis. Acta Radiol Suppl 369:192–196

    PubMed  CAS  Google Scholar 

  36. Hollinger P, Sturzenegger M, Mathis J, Schroth G, Hess CW (2002) Acute disseminated encephalomyelitis in adults: a reappraisal of clinical, CSF, EEG, and MRI findings. J Neurol 249:320–329

    Article  PubMed  Google Scholar 

  37. Hurst EW (1941) Acute haemorrhagic leucoencephalitis: a previously undefined entity. Med J Aust 2:1–6

    Google Scholar 

  38. Hurwitz ES (1988) The changing epidemiology of Reye’s syndrome in the United States: further evidence for a public health success. JAMA 260:3178–3180

    Article  PubMed  CAS  Google Scholar 

  39. Hurwitz ES, Barrett MJ, Bregman D, Gunn WJ, Pinsky P, Schonberger LB, Drage JS, Kaslow RA, Burlington DB, Quinnan GV, . (1987) Public Health Service study of Reye’s syndrome and medications. Report of the main study. JAMA 257:1905–1911

    Article  PubMed  CAS  Google Scholar 

  40. Huynh HK, Dorovini–Zis K (1993) Effects of interferon–gamma on primary cultures of human brain microvessel endothelial cells. Am J Pathol 142:1265–1278

    PubMed  CAS  Google Scholar 

  41. Hynson JL, Kornberg AJ, Coleman LT, Shield L, Harvey AS, Kean MJ (2001) Clinical and neuroradiologic features of acute disseminated encephalomyelitis in children. Neurology 56:1308–1312

    PubMed  CAS  Google Scholar 

  42. Johnson RT (1987) The pathogenesis of acute viral encephalitis and postinfectious encephalomyelitis. J Infect Dis 155:359–364

    PubMed  CAS  Google Scholar 

  43. Johnson RT (1994) The virology of demyelinating diseases. Ann Neurol 36(Suppl):S54–S60

    Article  PubMed  Google Scholar 

  44. Johnson RT (1998) Other Postviral Syndromes. In:Viral infections of the nervous system. Lippincott–Raven, Philedelphia, pp 211–224

  45. Johnson RT (1998) Postinfectious Demyelinating Diseases. In:Viral infections of the nervous system. Lippincott– Raven, Phildelphia, pp 181–210

  46. Johnson RT, Cornblath DR (2003) Poliomyelitis and flaviviruses. Ann Neurol 53:691–692

    Article  PubMed  Google Scholar 

  47. Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG (2002) Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology 58:143–146

    Article  PubMed  CAS  Google Scholar 

  48. Kennard C, Swash M (1981) Acute viral encephalitis: its diagnosis and outcome. Brain 104:129–148

    PubMed  CAS  Google Scholar 

  49. Kennedy PG (2004) Viral encephalitis: causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry 75(Suppl 1):i10–i15

    Article  PubMed  Google Scholar 

  50. Khetsuriani N, Holman RC, Anderson LJ (2002) Burden of encephalitis–associated hospitalizations in the United States, 1988–1997. Clin Infect Dis 35:175–182

    Article  PubMed  Google Scholar 

  51. Kleemola M, Kayhty H (1982) Increase in titers of antibodies to Mycoplasma pneumoniae in patients with purulent meningitis. J Infect Dis 146:284–288

    PubMed  CAS  Google Scholar 

  52. Krueger JM, Walter J, Dinarello CA, Wolff SM, Chedid L (1984) Sleep–promoting effects of endogenous pyrogen (interleukin–1). Am J Physiol 246:R994–R999

    PubMed  CAS  Google Scholar 

  53. Kuker W, Nagele T, Schmidt F, Heckl S, Herrlinger U (2004) Diffusionweighted MRI in herpes simplex encephalitis: a report of three cases. Neuroradiology 46:122–125

    Article  PubMed  CAS  Google Scholar 

  54. Kuperan S, Ostrow P, Landi MK, Bakshi R (2003) Acute hemorrhagic leukoencephalitis vs ADEM: FLAIR MRI and neuropathology findings. Neurology 60:721–722

    PubMed  Google Scholar 

  55. Lakeman FD, Whitley RJ (1995) Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brainbiopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis 171:857–863

    PubMed  CAS  Google Scholar 

  56. Leake JA, Billman GF, Nespeca MP, Duthie SE, Dory CE, Meltzer HS, Bradley JS (2002) Pediatric acute hemorrhagic leukoencephalitis: report of a surviving patient and review. Clin Infect Dis 34:699–703

    Article  PubMed  Google Scholar 

  57. Lisak RP, Behan PO, Zweiman B, Shetty T (1974) Cell–mediated immunity to myelin basic protein in acute disseminated encephalomyelitis. Neurology 24:560–564

    PubMed  CAS  Google Scholar 

  58. Lisak RP, Zweiman B (1977) In vitro cell–mediated immunity of cerebrospinal– fluid lymphocytes to myelin basic protein in primary demyelinating diseases. N Engl J Med 297:850–853

    Article  PubMed  CAS  Google Scholar 

  59. Lyon G, Dodge PR, Adams RD (1961) The acute encephalopathies of obscure origin in infants and children. Brain 84:680–708

    PubMed  CAS  Google Scholar 

  60. Majid A, Galetta SL, Sweeney CJ, Robinson C, Mahalingam R, Smith J, Forghani B, Gilden DH (2002) Epstein– Barr virus myeloradiculitis and encephalomyeloradiculitis. Brain 125:159–165

    Article  PubMed  Google Scholar 

  61. Markus R, Brew BJ, Turner J, Pell M (1997) Successful outcome with aggressive treatment of acute haemorrhagic leukoencephalitis. J Neurol Neurosurg Psychiatry 63:551

    PubMed  CAS  Google Scholar 

  62. McCabe K, Tyler K, Tanabe J (2003) Diffusion–weighted MRI abnormalities as a clue to the diagnosis of herpes simplex encephalitis. Neurology 61:1015–1016

    PubMed  Google Scholar 

  63. McGrath N, Anderson NE, Croxson MC, Powell KF (1997) Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry 63:321–326

    Article  PubMed  CAS  Google Scholar 

  64. Mendez Ashla MF (2000) Delirium. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD (eds) Neurology in Clinical Practice. Butterworth–Heinemann, Boston, p 25

  65. Misra UK, Kalita J (2002) Prognosis of Japanese encephalitis patients with dystonia compared to those with parkinsonian features only. Postgrad Med J 78:238–241

    Article  PubMed  CAS  Google Scholar 

  66. Mizuguchi M (1997) Acute necrotizing encephalopathy of childhood: a novel form of acute encephalopathy prevalent in Japan and Taiwan. Brain Dev 19:81–92

    Article  PubMed  CAS  Google Scholar 

  67. Nash D, Mostashari F, Fine A, Miller J, O’Leary D, Murray K, Huang A, Rosenberg A, Greenberg A, Sherman M, Wong S, Layton M (2001) The outbreak ofWest Nile virus infection in the New York City area in 1999. N Engl J Med 344:1807–1814

    Article  PubMed  CAS  Google Scholar 

  68. Neilson DE, Eiben RM, Waniewski S, Hoppel CL, Varnes ME, Bangert BA, Wiznitzer M, Warman ML, Kerr DS (2003) Autosomal dominant acute necrotizing encephalopathy. Neurology 61:226–230

    Article  PubMed  CAS  Google Scholar 

  69. Nicolosi A, Hauser WA, Beghi E, Kurland LT (1986) Epidemiology of central nervous system infections in Olmsted County, Minnesota, 1950–1981. J Infect Dis 154:399–408

    PubMed  CAS  Google Scholar 

  70. Papadopoulos MC, Davies DC, Moss RF, Tighe D, Bennett ED (2000) Pathophysiology of septic encephalopathy: a review. Crit Care Med 28:3019–3024

    Article  PubMed  CAS  Google Scholar 

  71. Papadopoulos MC, Lamb FJ, Moss RF, Davies DC, Tighe D, Bennett ED (1999) Faecal peritonitis causes oedema and neuronal injury in pig cerebral cortex. Clin Sci (Lond) 96:461–466

    Article  PubMed  CAS  Google Scholar 

  72. Plum F, Posner JB (1980) The diagnosis of stupor and coma. Philadelphia: Davis

  73. Prineas JW, McDonald I, Franklin RJM (2002) Demyelinating diseases. In: Graham DI, Lantos PL (eds) Greenfield’s Neuropathology. Arnold, London, pp 471–550

  74. Puchhammer–Stockl E, Presterl E, Croy C, Aberle S, Popow–Kraupp T, Kundi M, Hofmann H, Wenninger U, Godl I (2001) Screening for possible failure of herpes simplex virus PCR in cerebrospinal fluid for the diagnosis of herpes simplex encephalitis. J Med Virol 64:531–536

    Article  PubMed  CAS  Google Scholar 

  75. Quagliarello VJ, Wispelwey B, Long WJ Jr, Scheld WM (1991) Recombinant human interleukin–1 induces meningitis and blood–brain barrier injury in the rat. Characterization and comparison with tumor necrosis factor. J Clin Invest 87:1360–1366

    Article  PubMed  CAS  Google Scholar 

  76. Rantalaiho T, Farkkila M, Vaheri A, Koskiniemi M (2001) Acute encephalitis from 1967 to 1991. J Neurol Sci 184:169–177

    Article  PubMed  CAS  Google Scholar 

  77. Raschilas F, Wolff M, Delatour F, Chaffaut C, de Broucker T, Chevret S, Lebon P, Canton P, Rozenberg F (2002) Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis 35:254–260

    Article  PubMed  Google Scholar 

  78. Renault F, Arzimanoglou A, Rancurel G, Roy C, Harpey JP (1985) Hurst–type acute leukoencephalitis with complete recovery in a child. Presse Med 14:1959–1961

    PubMed  CAS  Google Scholar 

  79. Reye RD, Morgan G, Baral J (1963) Encephalopathy and fatty degeneration of the viscera. A disease entity in childhood. Lancet 91:749–752

    Article  PubMed  CAS  Google Scholar 

  80. Rotbart HA, Webster AD (2001) Treatment of potentially life–threatening enterovirus infections with pleconaril. Clin Infect Dis 32:228–235

    Article  PubMed  CAS  Google Scholar 

  81. Sahlas DJ, Miller SP, Guerin M, Veilleux M, Francis G (2000) Treatment of acute disseminated encephalomyelitis with intravenous immunoglobulin. Neurology 54:1370–1372

    PubMed  CAS  Google Scholar 

  82. Schloss L, van Loon AM, Cinque P, Cleator G, Echevarria JM, Falk KI, Klapper P, Schirm J, Vestergaard BF, Niesters H, Popow–Kraupp T, Quint W, Linde A (2003) An international external quality assessment of nucleic acid amplification of herpes simplex virus. J Clin Virol 28:175–185

    Article  PubMed  CAS  Google Scholar 

  83. Schwarz S, Mohr A, Knauth M, Wildemann B, Storch–Hagenlocher B (2001) Acute disseminated encephalomyelitis: a follow–up study of 40 adult patients. Neurology 56:1313–1318

    PubMed  CAS  Google Scholar 

  84. Sejvar JJ, Haddad MB, Tierney BC, Campbell GL, Marfin AA, Van Gerpen JA, Fleischauer A, Leis AA, Stokic DS, Petersen LR (2003) Neurologic manifestations and outcome ofWest Nile virus infection. JAMA 290:511–515

    Article  PubMed  Google Scholar 

  85. Sharshar T, Annane D, de la Grandmaison GL, Brouland JP, Hopkinson NS, Francoise G (2004) The neuropathology of septic shock. Brain Pathol 14:21–33

    Article  PubMed  Google Scholar 

  86. Skoldenberg B, Forsgren M, Alestig K, Bergstrom T, Burman L, Dahlqvist E, Forkman A, Fryden A, Lovgren K, Norlin K (1984) Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet 2:707–711

    Article  PubMed  CAS  Google Scholar 

  87. Solomon T (2003) Exotic and emerging viral encephalitides. Curr Opin Neurol 16:411–418

    Article  PubMed  Google Scholar 

  88. Solomon T, Dung NM, Kneen R, Gainsborough M, Vaughn DW, Khanh VT (2000) Japanese encephalitis. J Neurol Neurosurg Psychiatry 68:405–415

    Article  PubMed  CAS  Google Scholar 

  89. Sprung CL, Cerra FB, Freund HR, Schein RM, Konstantinides FN, Marcial EH, Pena M (1991) Amino acid alterations and encephalopathy in the sepsis syndrome. Crit Care Med 19:753–757

    PubMed  CAS  Google Scholar 

  90. Sydenham T (1788) Of the continued fever of the years 1673, 1674, 1675. In: Wallis G (ed) The work of Thomas Sydenham MD on acute and chronic disease with annotations by George Wallis. Robinson, Otridge, Hayes and Newbery, London, p 299

  91. Tarafdar K, Rao S, Recco RA, Zaman MM (2001) Lack of sensitivity of the latex agglutination test to detect bacterial antigen in the cerebrospinal fluid of patients with culture–negative meningitis. Clin Infect Dis 33:406–408

    Article  PubMed  CAS  Google Scholar 

  92. Tenembaum S, Chamoles N, Fejerman N (2002) Acute disseminated encephalomyelitis: a long–term follow–up study of 84 pediatric patients. Neurology 59:1224–1231

    PubMed  Google Scholar 

  93. Tien RD, Felsberg GJ, Osumi AK (1993) Herpesvirus infections of the CNS: MR findings. Am J Roentgenol 161:167–176

    CAS  Google Scholar 

  94. Van Coster RN, De Vivo DC, Blake D, Lombes A, Barrett R, DiMauro S (1991) Adult Reye’s syndrome: a review with new evidence for a generalized defect in intramitochondrial enzyme processing. Neurology 41:1815–1821

    PubMed  CAS  Google Scholar 

  95. Whitley RJ, Alford CA, Hirsch MS, Schooley RT, Luby JP, Aoki FY, Hanley D, Nahmias AJ, Soong SJ (1986) Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med 314:144–149

    Article  PubMed  CAS  Google Scholar 

  96. Whitley RJ, Cobbs CG, Alford CA Jr, Soong SJ, Hirsch MS, Connor JD, Corey L, Hanley DF, Levin M, Powell DA (1989) Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral Study Group. JAMA 262:234–239

    Article  PubMed  CAS  Google Scholar 

  97. Whitley RJ, Gnann JW (2002) Viral encephalitis: familiar infections and emerging pathogens. Lancet 359:507–513

    Article  PubMed  Google Scholar 

  98. Whitley RJ, Soong SJ, Linneman C Jr, Liu C, Pazin G, Alford CA (1982) Herpes simplex encephalitis. Clinical Assessment. JAMA 247:317–320

    Article  PubMed  CAS  Google Scholar 

  99. Young GB, Bolton CF, Archibald YM, Austin TW, Wells GA (1992) The electroencephalogram in sepsis–associated encephalopathy. J Clin Neurophysiol 9:145–152

    Article  PubMed  CAS  Google Scholar 

  100. Young GB, Bolton CF, Austin TW, Archibald YM, Gonder J, Wells GA (1990) The encephalopathy associated with septic illness. Clin Invest Med 13:297–304

    PubMed  CAS  Google Scholar 

  101. Zauner C, Gendo A, Kramer L, Funk GC, Bauer E, Schenk P, Ratheiser K, Madl C (2002) Impaired subcortical and cortical sensory evoked potential pathways in septic patients. Crit Care Med 30:1136–1139

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Guy’s & St Thomas’Hospitals NHS Trust, London, UK

    N. W. S. Davies, M. K. Sharief & R. S. Howard

  2. Batten-Harris Neurological Intensive Care Unit, The National Hospital for Neurology and Neurosurgery, London, UK

    N. W. S. Davies & R. S. Howard

  3. Department of Clinical Neurosciences, Hodgkin Building, Guy’s Hospital, London, SE1 1 UL, UK

    N. W. S. Davies & M. K. Sharief

Authors
  1. N. W. S. Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. K. Sharief
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. S. Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. W. S. Davies.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Davies, N.W.S., Sharief, M.K. & Howard, R.S. Infection–associated encephalopathies—their investigation, diagnosis, and treatment . J Neurol 253, 833–845 (2006). https://doi.org/10.1007/s00415-006-0092-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-006-0092-4

Key words

Search

Navigation