Update on investigation and management of postinfectious encephalitis.
OBJECTIVE
Encephalitis is a complex syndrome associated with significant morbidity and mortality. Despite biological and neuroimaging investigations, the cause of encephalitis remains undetermined in more than half of the cases. The aim of this review was to describe available data concerning diagnosis and treatment of postinfectious encephalitis, focusing on acute disseminated encephalomyelitis (ADEM) and acute hemorrhagic leukoencephalitis (AHLE).


RESULTS
The increasing availability of brain MRI studies has allowed a better delineation of diagnosis and prognosis of postinfectious central nervous system disorders. Beneficial effects of steroids and plasma exchange have been described in the most severe forms of postinfectious encephalitis, including ADEM and AHLE, but randomized controlled studies are lacking. Intravenous immunoglobulins may be of value in ADEM with peripheral nerve involvement and for patients in whom corticosteroid therapy is contraindicated.


CONCLUSIONS
Postinfectious encephalitis needs to be identified early in the management of patients with unexplained encephalitis as it represents a treatable disease. Randomized studies are needed in order to assess the potential benefit of early combined immunotherapy in ADEM.
Sonneville
Romain
R
Department of Critical Care Medicine and Infectious Diseases, Bichat-Claude Bernard Hospital, Université Paris 7, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. rsonneville@gmail.com
Klein
Isabelle F
IF
Wolff
Michel
M
D000818:Animals; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D002986:Clinical Trials as Topic / Q000592:standards; D042241:Early Diagnosis; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000639:trends; D010956:Plasmapheresis / Q000639:trends; D013256:Steroids / Q000627:therapeutic use
D016756:Immunoglobulins, Intravenous; D013256:Steroids