National Guideline Clearinghouse | Viral meningoencephalitis: a review of diagnostic methods and guidelines for management.

Guideline Title
Viral meningoencephalitis: a review of diagnostic methods and guidelines for management.

Bibliographic Source(s)
Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PG. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2010 Aug;17(8):999-e57. [99 references] PubMed

Guideline Status
This is the current release of the guideline.

This guideline updates a previous version: Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PG. Viral encephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2005 May;12(5):331-43.

full-text:
National Guideline Clearinghouse | Viral meningoencephalitis: a review of diagnostic methods and guidelines for management.





Eur J Neurol. 2010 Aug;17(8):999-e57. Epub 2010 Mar 3.
Viral meningoencephalitis: a review of diagnostic methods and guidelines for management.
Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PG.
SourceDepartment of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tiqva, Israel. isteiner@cc.huji.ac.il


Abstract
BACKGROUND: Viral encephalitis is a medical emergency. The prognosis depends mainly on the pathogen and host immunologic state. Correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury.

METHODS: We searched the literature from 1966 to 2009. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear, we have stated our opinion as good practice points.

RECOMMENDATIONS: Diagnosis should be based on medical history and examination followed by CSF analysis for protein and glucose levels, cellular analysis, and identification of the pathogen by polymerase chain reaction amplification (recommendation level A) and serology (level B). Neuroimaging, preferably by MRI, is essential (level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be performed immediately, LP should be delayed only under unusual circumstances. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. Patients must be hospitalized with easy access to intensive care units. Specific, evidence-based, antiviral therapy, acyclovir, is available for herpes encephalitis (level A) and may also be effective for varicella-zoster virus encephalitis. Ganciclovir and foscarnet can be given to treat cytomegalovirus encephalitis, and pleconaril for enterovirus encephalitis (IV class evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective, and their use is controversial, but this important issue is currently being evaluated in a large clinical trial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management.

PMID:20236175[PubMed - indexed for MEDLINE]
Viral meningoencephalitis: a review of diagnostic ... [Eur J Neurol. 2010] - PubMed result