Diagnostic approaches for patients with suspected encephalitis

Bloch, Karen C.; Glaser, Carol

doi:10.1007/s11908-007-0049-5

Cited by 42 publications

(42 citation statements)

References 59 publications

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“…In contrast, encephalitis is characterized by brain inflammation as a consequence of direct infection of the brain parenchyma, a post-infectious process such as acute disseminated encephalomyelitis (ADEM) [6,15], or a noninfectious condition such as anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis [16,17]. In the absence of pathologic evidence of brain inflammation, an inflammatory response in the cerebrospinal fluid (CSF) or the presence of parenchymal abnormalities on neuroimaging are often used as surrogate markers of brain inflammation.…”

Section: Priority 1: Case Definitionmentioning

confidence: 99%

Corticosteroid Treatment in Autoimmune Encephalitis

Sunwoo¹

2017

J Neurocrit Care

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Section: Priority 1: Case Definitionmentioning

confidence: 99%

Corticosteroid Treatment in Autoimmune Encephalitis

Sunwoo¹

2017

J Neurocrit Care

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“…Clinical signs mimicking encephalitis can appear due to infectious causes like bartonella hensela or influenca virus, which are known to be symptomatic for several days, yet without CSF pleocytosis (Bloch and Glaser 2007;van Zeijl et al 2005). Further, MRI imaging has been reported to be unremarkable in cerebral infections like CMV, non-polio enterovirus (Coxsackie, E 71), EBV, and rarely in HSV, as well as in VZV and adenovirus (Akyldz et al 2008;Grahn and Studahl 2015).…”

Section: Patients With Probable Viral Encephalitis and Normal Mrimentioning

confidence: 99%

A study on viral CNS inflammation beyond herpes encephalitis

et al. 2016

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The early diagnosis of herpes simplex virus encephalitis (HSVE) enables induction of antiviral therapy in this potentially life-threatening disease. The study aimed to determine clinical findings including cerebrospinal fluid (CSF) data and MRI imaging in HSVE patients and to identify features distinguishing HSVE from encephalitis of other viral etiologies. We retrospectively reviewed consecutive patients who were diagnosed with viral encephalitis between 2000 and 2014 at the University Hospital Halle. Forty-nine patients with viral encephalitis were identified. A viral etiology could be confirmed by PCR or antibody testing in 22/49 (44.9 %) of patients (15 (30.6 %) HSV, 5 (10.2 %) VZV, 2 (4.1 %) EBV). In HSVE, typical findings were focal slowing in electroencephalophy (EEG) (80 %, p = 0.021) and presence of cortical (86.7 %, p = 0.030) lesions in MRI. Restricted diffusion was particularly helpful in detection of early signal abnormalities in HSVE (p = 0.014). In 27/49 (55.1 %) of patients, no causative agent could be elucidated. In these patients, 15/27 (55.6 %) experienced a rather "benign" disease course with no MRI pathology despite initially HSVE mimicking clinical picture. However, CSF was significantly different showing a higher amount of granulocytes and activated lymphocytes. The remaining 12/27 (44.4 %) patients developed MRI changes consistent with encephalitis, in 4 of these patients, disease course was fatal. Beside PCR-based serology as standard procedure, MRI including diffusion-weighted images and EEG represent additional tools in early HSVE diagnosis. CSF cytology might be particularly supportive in differentiating likely benign forms of encephalitis.

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“…More recently, SLE infections have been For personal use only. (116), with most cases occurring in the coastal regions of the Gulf and mid-Atlantic states (138). The geographic variability between western equine encephalitis (WEE) and EEE is directly related to the range of their respective primary mosquito vectors (139).…”

Section: Other Arbovirusesmentioning

confidence: 99%

“…However, their role in routine diagnostics remains limited to the research setting at this time (138). The main factor limiting the utility of PCR is the relatively short period of viremia, with undetectable viral levels at the onset of CNS or systemic disease.…”

Section: Pcr Detectionmentioning

confidence: 99%

Infections of the Central Nervous System

Reznicek¹,

Bloch²,

Tang³

2010

Infectious Disease and Therapy

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INTRODUCTIONViral infections of the central nervous system (CNS) often present a diagnostic dilemma. The number of causative agents is vast, much greater than a century ago, when the established etiologies of CNS infections were mainly limited to rabies virus and polio virus. The physical findings of CNS infection are often nonspecific, and initial laboratory results may provide few additional clues as to the etiology. Molecular diagnostic testing has dramatically improved the ability to detect viral CNS infections, but requires expertise in the attributes and limitations of these techniques. Even discriminating infectious from noninfectious causes may be challenging, as metabolic, autoimmune, neoplastic, toxic, and endocrinologic entities may mimic meningitis or encephalitis. CNS infections represent syndromes where close collaboration between clinicians and laboratorians is crucial in providing a rapid diagnostic evaluation and an appropriate interpretation of results.This chapter concentrates on viral infections of the CNS in immunocompetent adults, with a focus on assessment and laboratory evaluation. The close anatomical proximity of meninges and brain parenchyma often blurs the distinction between meningitis and encephalitis, causing an overlap syndrome termed meningoencephalitis. For the purposes of this chapter, meningoencephalitis will be considered a subset of encephalitis, while meningitis will refer to isolated inflammation of the meninges. There is significant geographic variability with respect to the microbiology of CNS infections, and the following discussion will highlight the most significant viral pathogens in the United States. A brief overview of laboratory diagnostic techniques will initially be provided followed by a more detailed discussion specifically relating to the various viral pathogens.

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Diagnostic approaches for patients with suspected encephalitis

Cited by 42 publications

References 59 publications

Corticosteroid Treatment in Autoimmune Encephalitis

Corticosteroid Treatment in Autoimmune Encephalitis

A study on viral CNS inflammation beyond herpes encephalitis

Infections of the Central Nervous System

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