Zusammenfassung
Virale Infektionen des zentralen Nervensystems (ZNS) entwickeln sich meist im Rahmen
von Allgemeininfektionen und können sich als Meningitis, Enzephalitis, Myelitis, Radikulomyelitis
oder isolierte Hirnnervenläsionen manifestieren. Die virale Meningitis ist die häufigste
entzündliche Erkrankung des ZNS und wird wegen ihres blanden Verlaufs oft nicht diagnostiziert.
Die virale Meningoenzephalitis kann je nach Erreger und Immunstatus des Patienten
schwere, lebensbedrohliche Verläufe und Folgeschäden aufweisen. Die Diagnostik ist
durch die modernen bildgebenden, molekularbiologischen und infektiologischen Verfahren
zunehmend einfacher geworden. Inzwischen gelingt eine Identifikation des Virus durch
Zuhilfenahme hochsensitiver Techniken wie der Polymerasekettenreaktion (PCR) in 50
- 70 % der Fälle und nimmt weiter zu. Teilweise steht eine spezifische antivirale
Therapie zur Verfügung, derzeit wird auch eine Reihe von neuen antiviralen Substanzen
für die klinische Anwendung getestet. Bei vielen viralen Meningoenzephalitiden stehen
jedoch die symptomatische Behandlung und Allgemeinmaßnahmen im Vordergrund. Durch
Spontanmutationen, verändertes Reiseverhalten der Bevölkerung und veränderte klimatische
Bedingungen können neue Epidemien ausgelöst werden. Kürzlich aufgetretene Enzephalitisepidemien,
zum Beispiel durch das Enterovirus Typ 71, das West-Nile-Virus oder das Nipah-Virus,
zeigten die potenzielle Gefahr dieser Viren auf.
Abstract
Viral infections of the Central Nervous System (CNS) commonly evolve in the setting
of general infection and can cause meningitis, encephalitis, myelitis, radiculomyelitis
or cranial nerve palsy, or combinations of these syndroms. Viral meningitis is the
most common inflammatory disease of the CNS, the diagnosis is commonly missed because
of its relatively benign evolution. Viral meningoencephalitis can be life-threatening
and cause severe sequelae, depending on the agent and the immune status of the host.
The diagnosis has become less complicated due to modern radiology, infectiology and
molecular biology techniques. The causative virus can be identified using highly sensitive
methods like the polymerase chain reaction (PCR). Presently, the viral agent can be
found in 50 to 70 % cases with PCR, and the sensitivity is increasingly better over
time. There are specific therapies for some infectious agents, and new antiviral substances
are actually being tested for clinical use. In many cases however, general and symptomatic
management remain the standard therapy for viral meningoencephalitis. New epidemics
may occur due to spontaneous mutations, travel, and climatic change. The potential
danger of viral spread has been highlighted by the recent West-Nile-Virus, Enterovirus
Type 71 and Nipah-Virus epidemics.
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PD Dr. Uta Meyding-Lamadé
Neurologische Universitätsklinik · Ruprecht-Karls-Universität Heidelberg
Im Neuenheimer Feld 400
69120 Heidelberg
Email: uta_meyding-lamade@med.uni-heidelberg.de
