Britton P N, Eastwood K, Paterson B, Durrheim D N, Dale R C, Cheng A C, Kenedi C, Brew B J, Burrow J, Nagree Y, Leman P, Smith D W, Read K, Booy R, Jones C A
Discipline of Paediatrics and Child Health and Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Sydney Medical School, University of Sydney, Sydney, Australia.
Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia.
Intern Med J. 2015 May;45(5):563-76. doi: 10.1111/imj.12749.
Encephalitis is a complex neurological syndrome caused by inflammation of the brain parenchyma. The management of encephalitis is challenging because: the differential diagnosis of encephalopathy is broad; there is often rapid disease progression; it often requires intensive supportive management; and there are many aetiologic agents for which there is no definitive treatment. Patients with possible meningoencephalitis are often encountered in the emergency care environment where clinicians must consider differential diagnoses, perform appropriate investigations and initiate empiric antimicrobials. For patients who require admission to hospital and in whom encephalitis is likely, a staged approach to investigation and management is preferred with the potential involvement of multiple medical specialties. Key considerations in the investigation and management of patients with encephalitis addressed in this guideline include: Which first-line investigations should be performed?; Which aetiologies should be considered possible based on clinical features, risk factors and radiological features?; What tests should be arranged in order to diagnose the common causes of encephalitis?; When to consider empiric antimicrobials and immune modulatory therapies?; and What is the role of brain biopsy?
脑炎是一种由脑实质炎症引起的复杂神经综合征。脑炎的管理具有挑战性，原因如下：脑病的鉴别诊断范围广泛；疾病进展通常迅速；往往需要强化支持治疗；并且有许多病因尚无确切治疗方法。在急诊环境中经常会遇到可能患有脑膜脑炎的患者，临床医生必须考虑鉴别诊断、进行适当检查并开始经验性抗菌治疗。对于需要住院且可能患有脑炎的患者，采用分阶段的调查和管理方法较为可取，可能需要多个医学专科的参与。本指南中涉及的脑炎患者调查和管理的关键考虑因素包括：应进行哪些一线检查？；根据临床特征、危险因素和影像学特征，应考虑哪些可能的病因？；为诊断脑炎的常见病因应安排哪些检查？；何时考虑经验性抗菌治疗和免疫调节治疗？；脑活检的作用是什么？
