Title:Viral Encephalitis in Adults: A Narrative Review
Volume: 17
Issue: 4
Author(s): Valentina Siciliano, Tommaso Rosà, Pierluigi Del Vecchio, Anna D'Angelillo, Mattia Brigida, Yaroslava Longhitano, Christian Zanza, Michele Cosimo Santoro, Marcello Candelli, Francesco Franceschi and Andrea Piccioni*
Affiliation:
- Department of Emergency Medicine, University Polyclinic Foundation A. Gemelli
IRCCS, Rome, Italy
Keywords:
Viral infection, central nervous system viral infection, encephalitis, haemophilus influenzae, herpesviridae infections, cerebrospinal fluid.
Abstract: Viral infections of the central nervous system cause frequent hospitalization. The pathogenesis
of viral encephalitis involves both the direct action of invading pathogens and the damage
generated by the inflammatory reaction they trigger. The type of signs and symptoms presented by
the patient depends on the severity and location of the ongoing inflammatory process. Most of the
viral encephalitides are characterized by an acute development, fever, variable alterations in consciousness
(confusion, lethargy, even coma), seizures (focal and generalized) and focal neurologic
signs. The specific diagnosis of encephalitis is usually based on lumbar puncture. Cerebrospinal
fluid examination should be performed in all patients unless absolutely contraindicated. Also, electroencephalogram
and neuroimaging play a prominent role in diagnosis. Airway protection, ventilatory
support, the management of raised intracranial pressure and correction of electrolyte disorders
must be immediately considered in a patient with altered mental status. The only therapy strictly recommended
is acyclovir in HSV encephalitis. The use of adjunctive glucocorticoids has poor-quality
evidence in HSV, EBV, or VZV encephalitis. The role of antiviral therapy in other types of viral
encephalitis is not well defined.
