Journal of Neurology

, Volume 248, Issue 6, pp 469–477

Viral infections of the CNS with special emphasis on herpes simplex infections

  • Erich Schmutzhard
ENS TEACHING REVIEW

DOI: 10.1007/s004150170155

Cite this article as:
Schmutzhard, E. J Neurol (2001) 248: 469. doi:10.1007/s004150170155

Abstract

Within the past decade the management of acute HSV I encephalitis has been improved dramatically by the advent of the polymerase chain reaction (PCR), a method which has become the gold standard of diagnosis of HSV I encephalitis, replacing diagnostic uncertainties and, avoiding, in particular, invasive brain biopsy.

Early detection of HSV II in the neonate is mandatory; however, prevention by Caesarean section and/or prenatal therapy of the mother are for this the best option.

Very recently the causative agent of Mollaret's meningitis has proved to be, at least in part, HSV I or II. So far prospective randomized therapeutic trials are awaited for the treatment of Mollaret's meningitis using intravenous acyclovir or the more modern oral forms of virostatics (famciclovir, valaciclovir). For decades the causative agent of facial palsy (Bell's palsy) has been sought; only with the advent of PCR has this question been answered. Although one single study indicates the superiority of a combination of acyclovir plus prednisone, this finding has to be confirmed by a large scale prospective randomised double blind study. Nevertheless, if other causes for the clinical/neurological syndrome of peripheral facial palsy have been excluded, a combination therapy with acyclovir plus prednisone seems to be indicated in a patient with Bell's palsy.

Key words Viral encephalitis Herpesviridae 

Copyright information

© Steinkopff Verlag 2001

Authors and Affiliations

  • Erich Schmutzhard
    • 1
  1. 1.Department of Neurology, University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria Tel.: +43-512504-3853 Fax: +43-512504-4243 e-mail: erich.schmutzhard@uibk.ac.atAT

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