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1、EuropeanJournalofNeurology2010,17:999–1009doi:10.1111/j.1468-1331.2010.02970.xEFNSGUIDELINESViralmeningoencephalitis:areviewofdiagnosticmethodsandguidelinesformanagementa,bcdefgI.Steiner,H.Budka,A.Chaudhuri,M.Koskiniemi,K.Sainio,O.SalonenhandP.G.E.KennedyabDepartmentofNeurology,RabinMedicalCe
2、nter,BeilinsonCampus,PetachTiqva;LaboratoryofNeurovirology,DepartmentofVirology,cdHadassahUniversityHospital,Jerusalem,Israel;InstituteofNeurology,MedicalUniversityofVienna,Wien,Austria;DepartmentofeNeurology,EssexCentreforNeurologicalSciences,QueenÕsHospital,Romford,UK;DepartmentofVirology,H
3、aartmanInstitute,fgUniversityofHelsinki;DepartmentofClinicalNeurophysiology,UniversityofHelsinki;HelsinkiMedicalImagingCenter,UniversityofhHelsinki,Helsinki,Finland;andDepartmentofNeurology,InstituteofNeurologicalSciences,SouthernGeneralHospital,Glasgow,Scotland,UKKeywords:Background:Viralenc
4、ephalitisisamedicalemergency.Theprognosisdependscentralnervoussystem,mainlyonthepathogenandhostimmunologicstate.Correctimmediatediagnosisandencephalitis,infection,introductionofsymptomaticandspecifictherapyhasadramaticinfluenceuponmeningitis,viralsurvivalandreducestheextentofpermanentbraininjur
5、y.Methods:Wesearchedtheliteraturefrom1966to2009.RecommendationswereReceived11November2009reachedbyconsensus.Wheretherewaslackofevidencebutconsensuswasclear,weAccepted7January2010havestatedouropinionasgoodpracticepoints.Recommendations:Diagnosisshouldbebasedonmedicalhistoryandexaminationfollow
6、edbyCSFanalysisforproteinandglucoselevels,cellularanalysis,andiden-tificationofthepathogenbypolymerasechainreactionamplification(recommenda-tionlevelA)andserology(levelB).Neuroimaging,preferablybyMRI,isessential(levelB).Lumbarpuncturecanfollowneuroimagingwhenimmediatelyavailable,butifthiscannot
7、beperformedimmediately,LPshouldbedelayedonlyunderunusualcircumstances.Brainbiopsyshouldbereservedonlyforunusualanddiagnosticallydifficultcases.Patientsmustbehospitalizedwitheasyaccesstointensivecareunits.Specific,evidence-based,antiviraltherapy,
