Zusammenfassung
In der Differenzialdiagnostik eines meningitischen oder meningoenzephalitischen Syndroms müssen erregerbedingte (infektiöse) Erkrankungen des Zentralnervensystems von nicht erregerbedingten Erkrankungen wie etwa einer Meningeosis carcinomatosa, einer Neurosarkoidose oder einer zerebralen Vaskulitis abgegrenzt werden. Es muss versucht werden, unter Berücksichtigung der folgenden 5 Kriterien die Diagnose zu stellen: anhand 1. des klinischen Verlaufs (akut, subakut oder chronisch), 2. des Liquorbefunds (z. B. Zelldifferenzierung, Eosinophilie, Glukoseerniedrigung und daraus resultierender mikrobiologischer Befunde), 3. möglicher Besonderheiten im Schädel-CT oder MRT (z. B. temporaler Herdbefund bei der Herpesenzephalitis, Läsionen im Thalamus bei FSME- und enterovirusbedingten Enzephalitiden), 4. möglicher extrakranialer Manifestationen (z. B. Endokarditis, Malignomerkrankung), 5. besonderer klinischer Konstellationen (z. B. prädisponierende Faktoren wie HIV-Infektion, Zustand nach Zeckenstich oder Erythema migrans).
Abstract
A differential diagnosis of meningitis or meningoencephalitis must distinguish between pathogen-induced (infectious) diseases of the central nervous system and non-pathogen related diseases, such as carcinomatous meningitis, neurosarcoidosis or cerebral vasculitis. A diagnosis should be made after considering the following five criteria: 1) the clinical course (acute, subacute, or chronic); 2) the findings of the cerebrospinal fluid analyses (e.g., cell differentiation, eosinophilia, decrease of glucose, and resulting findings of microbiological examinations); 3) any special findings on cranial CT or MRI (e.g., temporal lesion in herpes encephalitis, thalamic lesions in central European encephalitis and enterovirus-induced encephalitis; 4) any extracranial manifestations (e.g., endocarditis, malignoma); 5) special clinical constellations (e.g., predisposing factors such as HIV infection, previous tick bite, or erythema migrans).
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Prof. Dr. med. Hans-Walter Pfister
Neurologische Klinik · Klinikum Großhadern · Ludwig-Maximilians-Universität
Marchioninistraße 15
81377 München
