Raised intracranial pressure in acute viral encephalitis

Kumar, Gyanendra; Kalita, Jayantee; Misra, U. K.

doi:10.1016/j.clineuro.2009.03.004

Cited by 60 publications

(36 citation statements)

References 80 publications

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“…Several case series confirmed that decompressive craniectomy is a potential life-saving measure for the treatment of severe encephalitis-associated increased intracranial pressure. However, whether survival is associated with unacceptably high morbidity rates including postencephalitic epilepsy remains to be determined [41].…”

Section: Demographics and Clinical Characteristicsmentioning

confidence: 99%

Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management

Sellner

Trinka

2012

J Neurol

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Mortality related to herpes simplex virus encephalitis (HSE) dropped dramatically with the systematic initiation of antiviral treatment in encephalitic syndromes. Further efforts need to be taken to reduce long-term morbidity in the survivors. In this regard, the high rate of postencephalitic epilepsy, which is frequently refractory to medical treatment, contributes significantly to the unfavorable clinical outcome of the disease. Seizures during the acute phase of HSE are the main risk for the development of postencephalitic epilepsy. Yet, there are no randomized controlled trials for the management of acute seizures, preventive measures or the ideal duration of antiepileptic treatment. Hence, concepts for the medical treatment of seizures during the acute phase of HSE and postencephalitic epilepsy are eagerly awaited. Epilepsy surgery is a potential treatment option for the latter, but only promising in a subgroup of patients suffering from unilateral mesio-temporal lobe epilepsy and congruent neuropsychological impairment. Relapsing HSE and post-infectious autoimmune conditions can lead to seizures in the aftermath of acute HSE. These conditions need to be kept in mind in order to promptly assure the initiation of accurate diagnostic steps and respective treatment. The purpose of this review is to summarize the current pathogenetical understanding, clinical and diagnostic considerations, and treatment options of seizures in acute HSE and postencephalitic epilepsy.

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Section: Demographics and Clinical Characteristicsmentioning

confidence: 99%

Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management

Sellner

Trinka

2012

J Neurol

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“…Furthermore, Barnett et al [3] have demonstrated that 50% of patients (5 out of 10) in their series of HSE died due to cerebral edema and transtentorial herniation despite aggressive hyperosmolar therapy at an average 12 days after illness. Elevated ICP in acute viral encephalitis has been demonstrated to be a poor prognostic indicator and ICP monitoring has been reported to significantly alter management strategies [3,[18][19][20][21]. Management of HSE-associated cerebral edema and increased ICP is, therefore, a critical treatment strategy to allow for the best outcomes in this disease process.…”

Section: Discussionmentioning

confidence: 99%

“…In spite of this, there exists limited data on the appropriate indications for intracranial pressure monitoring and even less data on the appropriate medical as well as surgical management of intracranial hypertension in HSE [19]. Furthermore, most data pertinent to ICP monitoring and ICP management in viral encephalitis is extrapolated from the traumatic brain injury (TBI) literature, a completely different pathologic process [22].…”

Section: Discussionmentioning

confidence: 99%

A review of the combined medical and surgical management in patients with herpes simplex encephalitis

Safain

Roguski

Kryzanski

et al. 2015

Clinical Neurology and Neurosurgery

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“…A similar series of patients has previously been published with presumed viral meningitis-induced intracranial hypertension [8], but in general this type of nonspecific infectious etiology often goes unreported. Other infections leading to intracranial hypertension, in contrast, are widely recognized, most notably with bacterial, fungal, and tuberculous meningitis or meningoencephalitis [1–3], as well as Lyme disease [4], and viral encephalitis [12]. Increased intracranial pressure due to viral meningitis is less commonly identified, although associations with Varicella and very rarely Enterovirus have been described [5–7].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with abnormal findings on brain imaging that could potentially contribute to elevations in intracranial pressure were excluded. Patients presenting with confusion or altered mental status were excluded as these findings may suggest meningoencephalitis, which is more commonly known to cause elevations in intracranial pressure [12]. …”

Section: Methodsmentioning

confidence: 99%

Increased Intracranial Pressure in the Setting ofEnterovirusand Other Viral Meningitides

Beal

2017

Neurology Research International

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Increased intracranial pressure due to viral meningitis has not been widely discussed in the literature, although associations with Varicella and rarely Enterovirus have been described. Patients with increased intracranial pressure and cerebrospinal fluid analysis suggestive of a viral process are sometimes classified as having atypical idiopathic intracranial hypertension (IIH). However, a diagnosis of IIH requires normal cerebrospinal fluid, and therefore in these cases an infection with secondary intracranial hypertension may be a more likely diagnosis. Here seven patients are presented with elevated intracranial pressure and cerebrospinal fluid suggestive of viral or aseptic meningitis. Of these, 1 had Enterovirus and the remainder were diagnosed with nonspecific viral meningitis. These data suggest that viral meningitis may be associated with elevated intracranial pressure more often than is commonly recognized. Enterovirus has previously been associated with increased intracranial pressure only in rare case reports.

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Raised intracranial pressure in acute viral encephalitis

Cited by 60 publications

References 80 publications

Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management

Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management

A review of the combined medical and surgical management in patients with herpes simplex encephalitis

Increased Intracranial Pressure in the Setting ofEnterovirusand Other Viral Meningitides

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