Kernaussagen
Potenziell intensivpflichtige entzündliche Erkrankungen des Nervensystems kann man in Infektionskrankheiten, Komplikationen dieser Infektionskrankheiten, immunvermittelte Erkrankungen und Autoimmunerkrankungen einteilen.
Symptome, die das ZNS direkt betreffen sind u. a. Bewusstseinsstörung, fokale neurologische Symptome und epileptische Anfälle. Treten neurologische Symptome auf, muss man differenzialdiagnostisch stets an eine entzündliche ZNS-Erkrankung denken.
Ziel ist es, keine Zeit durch aufwendige Diagnostik zu verlieren und gleichzeitig dennoch eine zielgerichtete Behandlung zu ermöglichen.
Diagnostik und Therapie umfassen folgende Schritte:
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Sicherung der Vitalfunktionen, Behandlung akut lebensbedrohlicher Probleme
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neurologische Basisdiagnostik
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früher Therapiebeginn (oft empirisch)
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Komplettierung der neurologischen Diagnostik
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Anpassung der Therapie an die endgültige Diagnose
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Berücksichtigung rehabilitativer und psychischer Aspekte
Die ersten 3 genannten Maßnahmen sollten in einem sehr kurzen Zeitraum durchgeführt werden – möglichst innerhalb von 1 h nach Aufnahme in die Klinik.
Literatur
-
1
Bale Jr. J F, Murph J R.
Infections of the central nervous system in the newborn.
Clin Perinatol.
1997;
24
787-806
-
2
Tunkel A R, Glaser C A, Bloch K C et al.
The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America.
Clin Infect Dis.
2008;
47
303-327
-
3
Bizzarro M J, Dembry L M, Baltimore R S, Gallagher P G.
Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis.
Pediatrics.
2008;
121
689-696
-
4
Tunkel A R, Hartman B J, Kaplan S L et al.
Practice guidelines for the management of bacterial meningitis.
Clin Infect Dis.
2004;
39
1267-1284
-
5
Saez-Llorens X, McCracken Jr G H.
Bacterial meningitis in children.
Lancet.
2003;
361
2139-2148
-
6
Makwana N, Baines P B.
Myocardial dysfunction in meningococcal septic shock.
Curr Opin Crit Care.
2005;
11
418-423
-
7
Thwaites G, Chau T T, Mai N T et al.
Tuberculous meningitis.
J Neurol Neurosurg Psychiatry.
2000;
68
289-299
-
8
Mackert B M, Conradi J, Loddenkemper C et al.
Neurotuberculosis: a continuing clinical challenge.
Nervenarzt.
2008;
79
153-166
-
9
Yogev R, Bar-Meir M.
Management of brain abscesses in children.
Pediatr Infect Dis J.
2004;
23
157-159
-
10
Sheehan J P, Jane J A, Ray D K, Goodkin H P.
Brain abscess in children.
Neurosurg Focus.
2008;
24
E6
-
11
De Tiege X, Rozenberg F, Des Portes V et al.
Herpes simplex encephalitis relapses in children: differentiation of two neurologic entities.
Neurology.
2003;
61
241-243
-
12
Whitley R J, Kimberlin D W.
Herpes simplex encephalitis: children and adolescents.
Semin Pediatr Infect Dis.
2005;
16
17-23
-
13
Dube C M, Brewster A L, Baram T Z.
Febrile seizures: mechanisms and relationship to epilepsy.
Brain Dev.
2009;
31
366-371
-
14
Benseler S M, Silverman E, Aviv R I et al.
Primary central nervous system vasculitis in children.
Arthritis Rheum.
2006;
54
1291-1297
-
15
Nagel M A, Cohrs R J, Mahalingam R et al.
The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features.
Neurology.
2008;
70
853-860
-
16
Specchio N, Fusco L, Claps D, Vigevano F.
Epileptic encephalopathy in children possibly related to immune-mediated pathogenesis.
Brain Dev.
2010;
32
51-56
-
17
van Baalen A, Häusler M, Boor R et al.
Febrile infection-related epilepsy syndrome (FIRES): A nonencephalitic encephalopathy in childhood.
Epilepsia.
2010;
51
1323-1328
-
18
Stuve O, Nessler S, Hartung H P et al.
Acute disseminated encephalomyelitis. Pathogenesis, diagnosis, treatment, and prognosis.
Nervenarzt.
2005;
76
701-707
-
19
Ravaglia S, Piccolo G, Ceroni M et al.
Severe steroid-resistant post-infectious encephalomyelitis: general features and effects of IVIg.
J Neurol.
2007;
254
1518-1523
-
20
Garg R K.
Acute disseminated encephalomyelitis.
Postgrad Med J.
2003;
79
11-17
-
21
Kaplin A I, Krishnan C, Deshpande D M et al.
Diagnosis and management of acute myelopathies.
Neurologist.
2005;
11
2-18
-
22
Pittock S J, Lucchinetti C F.
Inflammatory transverse myelitis: evolving concepts.
Curr Opin Neurol.
2006;
19
362-368
-
23
Wingerchuk D M.
Diagnosis and treatment of neuromyelitis optica.
Neurologist.
2007;
13
2-11
-
24
Korinthenberg R.
Intravenous immunoglobulin treatment in children with Guillain-Barre syndrome.
Eur J Paediatr Neurol.
1998;
2
57-59
-
25
Korinthenberg R, Monting J S.
Natural history and treatment effects in Guillain-Barre syndrome: a multicentre study.
Arch Dis Child.
1996;
74
281-287
-
26
King R L, Lorch S A, Cohen D M et al.
Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger.
Pediatrics.
2007;
120
489-496
-
27
Dotis J, Iosifidis E, Roilides E.
Central nervous system aspergillosis in children: a systematic review of reported cases.
Int J Infect Dis.
2007;
11
381-393
-
28
Bicanic T, Harrison T S.
Cryptococcal meningitis.
Br Med Bull.
2004;
72
99-118
-
29
Zonios D I, Bennett J E.
Update on azole antifungals.
Semin Respir Crit Care Med.
2008;
29
198-210
-
30
Welch S B, Nadel S.
Treatment of meningococcal infection.
Arch Dis Child.
2003;
88
608-614
-
31
Enright A M, Prober C.
Antiviral therapy in children with varicella zoster virus and herpes simplex virus infections.
Herpes.
2003;
10
32-37
-
32
Mtitimila E I, Cooke R W.
Antibiotic regimens for suspected early neonatal sepsis.
Cochrane Database Syst Rev
2004;
CD004495
-
33
Gordon A, Jeffery H E.
Antibiotic regimens for suspected late onset sepsis in newborn infants.
Cochrane Database Syst Rev
2005;
CD004501
-
34
van de Beek D, de Gans J, McIntyre P, Prasad K.
Corticosteroids for acute bacterial meningitis.
Cochrane Database Syst Rev
2007;
CD004405
-
35
Pati S, Goodfellow J A, Iyadurai S, Hilton-Jones D.
Approach to critical illness polyneuropathy and myopathy.
Postgrad Med J.
2008;
84
354-360
-
36
Davydow D S, Richardson L P, Zatzick D F, Katon W J.
Psychiatric morbidity in pediatric critical illness survivors: a comprehensive review of the literature.
Arch Pediatr Adolesc Med.
2010;
164
377-385
Prof. Dr. Martin Häusler
Universitätsklinik für Kinder- und Jugendmedizin
Pauwelsstr. 30
52074 Aachen
Phone: 0241/800
Fax: 0241/8082484
Email: haeusler@rwth-aachen.de
