Viral Infections of the Central Nervous System

Dede Gunawan Dept of Neurology Hasan Sadikin Hosp. /Padjadjaran Univ.

Viral Infections

Any type of Virus may invade the CNS Depends on the host immunity. Some virus give symptoms only of the already invade the CNS. Virus are insensitive to Antibiotics !! There are only limited anti viral agents

Type of Virus

RNA: Replicate within the cytoplasm: Enterovirus : Polio, Coxsackie, Enterovirus 70,71 Toga v. : Equine E.s, Jap E. Paramixovirus :Measles (SSPE),Mups, Nipah Rabdo virus : Rabies Retrovirus : HIV /HTLV

Type of Virus 2

DNA Virus : Herpes virus : Herpes simplex Varicella-Zoster Cytomegalovirus Epstein-Barr Papovirus : Progr. Multifocal Leuko encephalitis

Clinical Manifestations

Meningitis: Fever, Headache , neckstiffnes Encephalitis : + Sign of Brain Parenchymal involvement , lowering on consciousness, convulsions, focal neurological abnormalities. Meningo-encephalitis Myelitis Paralytic diseases : Polio

Approach to CNS Viral Infections

At present with limited resources, direct diagnosis is often difficult Certain cases are classic like : Rabies , Polio ( now not anymore ) Exclude other microbial infections: Bacterial , parasitic and Fungal , where causal treatment is theoretically possible

Make a clinical appraisal

History ; onset of illness , travel ?, habit , occupation , past illness Physical examination :fever , consciousness, neck stiffness , sign of paralysis , convulsions ?

Laboratory examination

Complete blood check Cerebrspinal fluid examinations; routine check may exclude bacterial , fungal , parasitic infections

Serological , PCR test for suspected organism , Tissue culture for virus.

Neuro Physiology

EEG : Spesific for certain cases : Herpes Simplex, SSPE EMG , Evoked potensial , mostly useful in the post acute stage

Neuro-Imaging

Ct Scan , not helpful in most cases MRI : Imaging of choice

Most often found Viral infections

Endemic : Herpes simpleks EEG , Imaging may help Serological / PCR of CSF /Blood Tretment with i.v. Acyclovir early

Other Viral Infections

SSPE , mostly in post measles infections . No Cure , Vaccination effective in preventing Japanese Encephalitis: Endemic where pigs are raised in household . No antiviral , vaccine +

Other Viral Infections 2

West Nile ; Easily spread by birds when present

Human Immunodefficency Virus ( HIV ) At present no 1 , infectious disease killer In the World. Most of the time atmitted after opportunistic infections appear

Nipah Encephalitis

New Virus found in Malaysia in 1997-98 As it happened among pig farmers , first though to be Japanese E. New Paramixovirus type , spread by Bats In Malaysia predominant Encephalitic But last one in Bangladesh , Burma , predominant pulmonary infections , and humam to human spread

Conclusion

1. Most of the time no specific viral sign 2 exclude possibility of other microbial infections 3 in suspected Herpes group begin Acyclovir early 4. treatment mostly supportive