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Journal of Neurology

, Volume 252, Issue 3, pp 268–272 | Cite as

Viral encephalitis

  • Peter G. E. Kennedy
ENS TEACHING REVIEW

Abstract

Acute viral encephalitis may be caused by a wide range of viruses but the most important is herpes simplex encephalitis (HSE) because of its severity, especially if untreated, and its good response to specific treatment with acyclovir. The outcome of any CNS viral infection is dependent on both the immune status of the host and the virulence of the infecting virus. In evaluating a patient with suspected viral encephalitis there are 3 essential steps, namely the identification of a true parenchymal virus infection of the brain rather than a non–infective encephalopathy, the distinction of an infectious viral encephalitis from an acute disseminated encephalomyelitis (ADEM), and then the determination, where possible, of the specific virus involved. In practice, the precise viral cause of the encephalitis may never be established. Analysis of the CSF for herpes simplex virus (HSV) DNA using the Polymerase Chain Reaction (PCR) has been a significant advance in the diagnosis of HSE as this test has a very high sensitivity and specificity especially with appropriate sample timing. It is essential to commence early treatment with intravenous acyclovir in patients suspected of having HSE because of the remarkable safety and efficacy of this drug and the dangers of delaying potentially effective treatment of life threatening disease. This review outlines the general management approach in patients suspected of having viral encephalitis.

Key words

viral encephalitis acyclovir herpes simplex virus CSF PCR 

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References

  1. 1.
    Baringer JR (2002) Herpes Simplex virus encephalitis. In: Davis LE, Kennedy PGE (eds) Infectious Diseases of the Nervous System, 1st edn. Butterworth-Heinemann, pp 139–164Google Scholar
  2. 2.
    Booss J, Esiri MM (2003) Viral Encephalitis in Humans. ASM Press, WashingtonGoogle Scholar
  3. 3.
    Chaudhuri A, Kennedy PGE (2002) Diagnosis and treatment of viral encephalitis. Postgrad Med J 78:575–583Google Scholar
  4. 4.
    Cinque P, Cleator GM, Weber T, et al. (1996) The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report. J Neurol Neurosurg Psychiatry 61:339–345Google Scholar
  5. 5.
    Coyle PK (2000) Postinfectious encephalomyelitis. In: Davis LE, Kennedy PGE (eds) Infectious diseases of the Nervous System, 1st edn. Butterworth- Heinemann, pp 83–108Google Scholar
  6. 6.
    Davis LE (2000) Diagnosis and treatment of acute encephalitis. The Neurologist 6:145–159Google Scholar
  7. 7.
    Fodor PA, Levin MJ, Weinberg A, et al. (1998) Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF. Neurology 51:554–559Google Scholar
  8. 8.
    Johnston RT (1998) Viral infections of the nervous system, 2nd edn. Lippincott- Raven, PhiladelphiaGoogle Scholar
  9. 9.
    Johnson RT (2003) Emerging viral infections of the nervous system. J Neurovirol 9:140–147Google Scholar
  10. 10.
    Kennedy PGE (2004) Viral encephalitis: causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry 75(Suppl 10):i10–i15Google Scholar
  11. 11.
    Kennedy PGE, Chaudhuri A (2002) Herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 73:237–238Google Scholar
  12. 12.
    Koskiniemi M, Rantalaiho T, Piiparinen H, et al. (2001) Infections of the central nervous system of suspected viral origin: A collaborative study from Finland. J Neurovirol 7:400–408Google Scholar
  13. 13.
    Kurt-Jones EA, Chan M, Zhou S, Wang J, Reed G, Bronson R, Arnold MM, Knipe DM, Finberg RW (2004) Herpes simplex virus 1 interaction with Tolllike receptor 2 contributes to lethal encephalitis. Proc Natl Acad Sci USA 101:1315–1320Google Scholar
  14. 14.
    Solomon T (2003) Recent advances in Japanese encephalitis. J Neurovirol 9:274–283Google Scholar
  15. 15.
    Whitley RJ, Gnann JW (2002) Viral encephalitis: familiar infections and emerging pathogens. Lancet 359:507–514Google Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  1. 1.Department of Neurology, Division of Clinical NeurosciencesSouthern General Hospital, Institute of Neurological SciencesGlasgow G51 4TFUK

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