From the Guidelines
Post-viral encephalitis should be treated with antiviral medications, such as aciclovir (10 mg/kg three times daily intravenously) for up to 14 days, especially if it can be started within a few days of symptom onset, as recommended by the Association of British Neurologists and British Infection Association national guidelines 1.
Treatment Approach
The primary goal of treatment is to reduce the severity of the disease and prevent long-term neurological damage.
- Antiviral medications, such as aciclovir, are the mainstay of treatment for post-viral encephalitis, particularly for herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections 1.
- The dose of aciclovir should be adjusted for patients with impaired renal function, and renal function must be reviewed frequently 1.
- A course of steroids (for example, 60-80 mg of prednisolone daily for 3 to 5 days) is also often given, because of the inflammatory nature of the lesion 1.
- Supportive care is essential, including management of increased intracranial pressure, seizure control with anticonvulsants, and respiratory support if needed.
Diagnostic Approach
- Prompt diagnosis through lumbar puncture, brain imaging (MRI preferred over CT), and EEG is crucial for appropriate management.
- The severity and prognosis depend on the causative virus, patient age, immune status, and how quickly treatment was initiated.
Special Considerations
- In immunocompromised patients with VZV encephalitis, a prolonged course of intravenous aciclovir may be needed 1.
- Intravenous immunoglobulin has been used in patients with chronic enterovirus meningitis and may also be useful in patients with severe enterovirus 71 infection, though no randomized trials have been conducted 1.
From the Research
Post Viral Encephalitis
- Post viral encephalitis is a serious condition that can lead to significant morbidity and mortality if not promptly diagnosed and treated 2.
- The prognosis of post viral encephalitis depends on the specific pathogen and the immunological state of the host 2.
- Herpes simplex virus (HSV) encephalitis is a common cause of post viral encephalitis, and its mortality rate has decreased significantly with the introduction of antiviral treatment 3.
Diagnosis and Management
- Diagnosis of post viral encephalitis should be based on medical history, examination, and analysis of cerebrospinal fluid (CSF) for protein and glucose contents, cellular analysis, and identification of the pathogen by polymerase chain reaction (PCR) amplification and serology 2.
- Neuroimaging, preferably by magnetic resonance imaging (MRI), is an essential aspect of evaluation, and lumbar puncture should be performed promptly unless there are strict contraindications 2.
- Treatment of HSV encephalitis with acyclovir dramatically improves outcome, but the optimal management of autoimmune encephalitis is still uncertain 4.
- Supportive therapy, including management of seizures and raised intracranial pressure, is crucial in the management of post viral encephalitis 2.
Complications and Sequelae
- Post viral encephalitis can lead to significant long-term morbidity, including seizures, epilepsy, and neuropsychological deficits 3, 4.
- Autoimmune encephalitis can be triggered by HSV and should be considered in patients who are not responding to treatment 5.
- Recurrent viral encephalitis can occur, and chromosomally integrated Human Herpesvirus 6 (HHV-6) can present with persistently high plasma viral loads, making treatment challenging 6.