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Post-infectious encephalitis in adults: diagnosis and management
R Sonneville1, I Klein, T de Broucker
1Department of Critical Care Medicine and Infectious Diseases, Bichat-Claude Bernard Hospital, Université Paris 7, 46 Rue Henri Huchard, 75877 Paris Cedex 18, France. rsonneville@yahoo.com
The Journal of Infection
|April 17, 2009
Summary
Acute disseminated encephalomyelitis (ADEM) is an immune-mediated CNS disorder following infection. Diagnosis relies on MRI, and treatment includes steroids, with generally favorable outcomes.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Central nervous system (CNS) syndromes can arise after microbial infections.
- Severe post-infectious encephalitis forms include acute disseminated encephalomyelitis (ADEM), acute hemorrhagic leukoencephalitis, and Bickerstaff's brainstem encephalitis.
- ADEM is an immune-mediated inflammatory demyelinating CNS disorder with a typical 2-30 day latency period post-infection.
Purpose of the Study:
- To describe the clinical characteristics, diagnosis, and management of ADEM.
- To highlight the diagnostic importance of neuroimaging in ADEM.
- To discuss treatment options and patient outcomes for ADEM.
Main Methods:
- Clinical case review and analysis of diagnostic findings.
- Cerebrospinal fluid (CSF) analysis to rule out direct CNS infection.
- Cerebral magnetic resonance imaging (MRI) to detect characteristic white matter lesions.
Main Results:
- ADEM presents with acute focal neurological signs and encephalopathy, potentially requiring intensive care.
- CSF analysis shows lymphocytic pleocytosis but no direct infection.
- MRI reveals diffuse or multifocal asymmetrical white matter lesions on T2- and FLAIR sequences.
Conclusions:
- ADEM is a distinct post-infectious CNS syndrome diagnosed primarily through MRI.
- High-dose intravenous steroids are the first-line treatment.
- While outcomes are typically favorable, recurrent or multiphasic forms of ADEM can occur.
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