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
