Université de Paris, INSERM UMR1148, team 6, 75018 Paris, France; AP-HP, intensive care medicine, Hôpital Bichat - Claude Bernard, 75018 Paris, France.
AP-HP, intensive care medicine, Hôpital Bichat - Claude Bernard, 75018 Paris, France.
Rev Neurol (Paris). 2022 Jan-Feb;178(1-2):48-56. doi: 10.1016/j.neurol.2021.12.002. Epub 2021 Dec 29.
Viral encephalitis is a severe syndrome that can lead to encephalopathy, seizures, focal deficits, and neurological sequelae and death. It is mainly caused by neurotropic herpes viruses (i.e., HSV and VZV), although other pathogens may be observed in specific geographic regions or conditions. Recent advances in neuroimaging and molecular biology (PCR, metagenomics) allow for faster and more accurate etiological diagnoses, although their benefits need to be confirmed to provide guidelines for their use and interpretation. Despite intravenous acyclovir therapy and supportive care, outcomes remain poor in about two-thirds of herpes encephalitis patients requiring ICU admission. Randomized clinical trials focusing on symptomatic measures (i.e. early ICU admission, fever control, and treatment of seizures/status epilepticus) or adjunctive immunomodulatory therapies (i.e. steroids, intravenous immunoglobulins) to improve neurologic outcomes have not been conducted in the ICU setting. Large prospective multicenter studies combining clinical, electrophysiological, and neuroimaging data are needed to improve current knowledge on care pathways, long-term outcomes, and prognostication.
病毒性脑炎是一种严重的综合征，可导致脑病、癫痫发作、局灶性缺损、神经后遗症和死亡。它主要由嗜神经疱疹病毒（即 HSV 和 VZV）引起，尽管在特定的地理区域或条件下可能观察到其他病原体。神经影像学和分子生物学（PCR、宏基因组学）的最新进展可实现更快、更准确的病因诊断，尽管需要证实其益处，以提供使用和解释的指南。尽管进行了静脉用阿昔洛韦治疗和支持性护理，但仍有大约三分之二需要入住 ICU 的疱疹性脑炎患者的预后较差。在 ICU 环境中，尚未开展针对症状性措施（即早期 ICU 入院、控制发热和治疗癫痫发作/癫痫持续状态）或辅助免疫调节治疗（即类固醇、静脉注射免疫球蛋白）以改善神经结局的随机临床试验。需要进行大型前瞻性多中心研究，结合临床、电生理学和神经影像学数据，以提高对护理途径、长期结局和预后的现有认识。
