Case Definitions, Diagnostic Algorithms, and Priorities in Encephalitis: Consensus Statement of the International Encephalitis Consortium

Venkatesan, Arun; Tunkel, Allan R.; Bloch, Karen C.; Lauring, Adam S.; Sejvar, James J.; Bitnun, Ari; Stahl, J.-P.; Mailles, Alexandra; Drebot, Michael A.; Rupprecht, Charles E.; Yoder, Jeffrey A.; Cope, Jennifer R.; Wilson, Michael R.; Whitley, Richard J.; Sullivan, John S.; Granerød, Julia; Jones, Cheryl; Eastwood, Keith; Ward, Katherine N.; Dürrheim, David N; Solbrig, Marylou V.; Liang, Guodong; Glaser, Carol; Sheriff, Heather; Brown, David; Farnon, Eileen C.; Messenger, Sharon; Paterson, Beverley J.; Soldatos, Ariane; Roy, Sharon L.; Visvesvara, Govinda S.; Beach, Michael; Nasci, Roger S.; Pertowski, Carol A.; Schmid, Scott; Rascoe, Lisa; Montgomery, Joel M.; Tong, Suxiang; Breiman, Robert F.; Franka, Richard; Keuhnert, Matt; Angulo, Fred; Cherry, James D.

doi:10.1093/cid/cit458

Cited by 816 publications

(740 citation statements)

References 84 publications

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“…Findings supportive of brain inflammation may include fever, new seizures, focal neurologic signs, cerebrospinal fluid (CSF) pleocytosis (≥5 nucleated cells/ml), and radiological and/or neurophysiologic abnormalities [e.g., contrast-enhancing lesions on magnetic resonance imaging (MRI) or abnormal findings on electroencephalography (EEG), respectively] [1]. Encephalitis must be distinguished from encephalopathy, a broader term that refers to a clinical state of disorientation, confusion, behavioral, and other cognitive changes that can occur in the setting of encephalitis, as well as numerous other noninflammatory conditions.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

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Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be lifesaving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.

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Section: Clinical Manifestationsmentioning

confidence: 99%

“…Encephalitis is inflammation of the brain parenchyma with neurologic dysfunction, and can result from infectious, postinfectious, and noninfectious causes [1]. Infection constitutes approximately 50 % of identifiable cases and is the most commonly identified etiologic category of encephalitis [2].…”

Section: Introductionmentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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“…Once the diagnosis of possible AE was made, routine evaluation was performed following the recommended evaluation algorithm of encephalitis to exclude of any other possible etiologies of encephalitis, including infective, tumors, or demyelinating CNS disease (e.g., Bickerstaff 's brainstem encephalitis, acute disseminated encephalomyelitis) [5,24]. The evaluation protocol for infectious etiologies used in our study is demonstrated in Supplemental Table 1.…”

Section: Study Populationmentioning

confidence: 99%

“…If the work-up for infectious etiologies was unrevealing, diagnosis of probable autoimmune encephalitis was made when at least 2 of the following criteria were satisfied: 1) MRI abnormalities suggestive of autoimmune encephalitis; 2) CSF pleocytosis or CSF-specific oligoclonal bands or elevated CSF IgG index; and 3) brain biopsy showing inflammatory infiltrates, excluding other disorders (e.g., tumor) [5,8,24].…”

Section: Study Populationmentioning

confidence: 99%

Tocilizumab in Autoimmune Encephalitis Refractory to Rituximab: An Institutional Cohort Study

et al. 2016

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A considerable portion of autoimmune encephalitis (AE) does not respond to conventional immunotherapies and subsequently has poor outcomes. We aimed to determine the efficacy of tocilizumab, an anti-interleukin-6 antibody, in rituximab-refractory AE compared with other treatment options. From an institutional cohort of AE, 91 patients with inadequate clinical response to first-line immunotherapy and following rituximab were retrospectively reviewed. Patients were grouped according to their further immunotherapy strategies. Thirty (33.0 %) patients were included in the tocilizumab group, 31 (34.0 %) in the additional rituximab group, and 30 (33.0 %) in the observation group. Outcomes were defined as the favorable modified Rankin Scale scores (≤2) at 1 and 2 months from the initiation of each treatment strategy and at the last follow-up. Favorable clinical response (improvement of the modified Rankin Scale scores by ≥ 2 points or achievement of the mRS scores ≤ 2) at the last follow-up was also analyzed. The tocilizumab group showed more frequent favorable mRS scores at 2 months from treatment initiation and at the last follow-up compared with those at the relevant time points of the remaining groups. The majority (89.5 %) of the patients with clinical improvement at 1 month from tocilizumab treatment maintained a long-term favorable clinical response. No serious adverse effects of rituximab or tocilizumab were reported. Therefore, we suggest that tocilizumab might be a good treatment strategy for treating AE refractory to conventional immunotherapies and rituximab. The tocilizumab-mediated clinical improvement manifests as early at 1 month after treatment initiation.

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“…A CT preceding the LP is indicated for patients with conditions such as moderate to severe impairment of consciousness (reduced or fluctuating GCS < 13), focal neurological signs, papilloedema, relative bradycardia with hypertension, systemic shock or impaired immunity [38]. A standard CSF examination (opening pressure, morphology, protein and glucose) should be followed by a CSF PCR test for HSV 1 and 2, VZV and enteroviruses [40]. If the CSF was not tested for viral DNA/RNA during the acute phase of the illness (10-14 days after the first signs), the CSF and blood plasma should be tested for HSV IgG antibody.…”

Section: Management In Cases Of Suspected and Confirmed Viral Encephamentioning

confidence: 99%

Psychiatric Aspects of Herpes Simplex Encephalitis, Tick-Borne Encephalitis and Herpes Zoster Encephalitis Among Immunocompetent Patients

2015

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The psychopathological symptoms occurring in the course of diseases associated with infections are often initially isolated and non-characteristic, and may cause diagnostic difficulties. Moreover, such disorders tend to be less responsive to psychiatric management. Among possible causes such as trauma, neoplasm and vascular changes, inflammatory changes of the brain as a result of a viral infection should also be considered. There were 452 registered cases of viral encephalitis in Poland in 2010, and although not very prevalent they remain a severe and lifethreatening condition. What is more, the frequently occurring neurological and psychiatric complications of viral encephalitis often result in permanent disabilities, causing a significant decrease in the quality of life. This article presents the three types of encephalitis that are most prevalent among immunocompetent patients in Poland, i.e. herpes simplex encephalitis (HSE), tick-borne encephalitis (TBE) and herpes zoster encephalitis (HZE). The psychopathology of the acute phase of the infection, the residual symptoms, features apparent in imaging studies and some neuropathological aspects are also presented. The paper also focuses on psychiatric aspects of the diagnostics and treatment of the described conditions. The clinical pictures of these infections are quite specific, although they cover a wide range of symptoms, and these characteristic features are described. The aim of this review is also to show the significance of thorough diagnostics and a multidisciplinary approach to patients with viral CNS infections (Adv Clin Exp Med 2015, 24, 2, 361-371).

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Case Definitions, Diagnostic Algorithms, and Priorities in Encephalitis: Consensus Statement of the International Encephalitis Consortium

Abstract: We anticipate that this document, representing a synthesis of our discussions and supported by literature, will serve as a practical aid to clinicians evaluating patients with suspected encephalitis and will identify key areas and approaches to advance our knowledge of encephalitis.

Cited by 816 publications

References 84 publications

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Tocilizumab in Autoimmune Encephalitis Refractory to Rituximab: An Institutional Cohort Study

Psychiatric Aspects of Herpes Simplex Encephalitis, Tick-Borne Encephalitis and Herpes Zoster Encephalitis Among Immunocompetent Patients

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