RESUMO
PURPOSE OF REVIEW: This article reviews the symptomatology, diagnosis, and treatment of neuroborreliosis. RECENT FINDINGS: The most recent guidelines for the diagnosis and treatment of Lyme disease were published in 2020 by the Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology. SUMMARY: The most common neurologic complications of Lyme disease are cranial neuritis (most often a unilateral or bilateral facial nerve palsy), meningitis, and radiculoneuritis/mononeuropathy multiplex. Testing for Lyme disease begins with an enzyme-linked immunosorbent assay (ELISA). If the ELISA is positive or borderline, Western blots should be performed for both IgM and IgG antibodies. As a general rule, in infectious diseases, an IgM antibody response is followed by an IgG antibody response. A central nervous system infection has either a CSF pleocytosis or pathogen-specific intrathecal antibody production. Lyme meningitis, cranial neuropathy, radiculoneuropathy, or other peripheral nervous system manifestations are treated with oral doxycycline or IV ceftriaxone, cefotaxime, or penicillin G. No additional antibiotic therapy is indicated for patients with posttreatment Lyme disease syndrome or patients with concern for chronic Lyme disease with no evidence of previous or current Lyme infection.
Assuntos
Doenças dos Nervos Cranianos , Neuroborreliose de Lyme , Meningite , Antibacterianos/uso terapêutico , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Ensaio de Imunoadsorção Enzimática , Humanos , Neuroborreliose de Lyme/complicações , Neuroborreliose de Lyme/diagnóstico , Neuroborreliose de Lyme/tratamento farmacológicoAssuntos
Viroses do Sistema Nervoso Central , Enterovirus Humano D/patogenicidade , Infecções por Enterovirus , Epidemias/prevenção & controle , Debilidade Muscular , Mielite , Doenças Neuromusculares , Vacinas Virais , Viroses do Sistema Nervoso Central/complicações , Viroses do Sistema Nervoso Central/epidemiologia , Viroses do Sistema Nervoso Central/prevenção & controle , Viroses do Sistema Nervoso Central/virologia , Pré-Escolar , Infecções por Enterovirus/complicações , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/prevenção & controle , Infecções por Enterovirus/virologia , Humanos , Debilidade Muscular/epidemiologia , Debilidade Muscular/etiologia , Debilidade Muscular/prevenção & controle , Debilidade Muscular/virologia , Mielite/complicações , Mielite/epidemiologia , Mielite/prevenção & controle , Mielite/virologia , Doenças Neuromusculares/complicações , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/prevenção & controle , Doenças Neuromusculares/virologiaRESUMO
Acute bacterial meningitis and spinal epidural abscess are neurological emergencies. Acute bacterial meningitis may present with symptoms as nonspecific as headache and fever, but rapid progression to an altered level of consciousness is not unusual. Spinal epidural abscess manifests initially as back pain, followed by radicular pain, then weakness, and finally paraplegia. Brain abscess may initially present only with headache, or as a new-onset seizure or with a focal neurological deficit. Bacterial infections of the central nervous system require emergent diagnosis and management. In this article, the pathogenesis, etiological organisms, diagnostic studies, differential diagnosis and management of acute bacterial meningitis, spinal epidural abscess, and brain abscess are discussed.
Assuntos
Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico , Abscesso Epidural/diagnóstico , Meningites Bacterianas/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Diagnóstico Diferencial , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/microbiologia , Humanos , Imageamento por Ressonância Magnética , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologiaRESUMO
OBJECTIVE: To delineate a comprehensive curriculum for fellowship training in neuroinfectious diseases, we conducted a modified Delphi approach to reach consensus among 11 experts in the field. METHODS: The authors invited a diverse range of experts from the American Academy of Neurology Neuro-Infectious Diseases (AAN Neuro-ID) Section to participate in a consensus process using a modified Delphi technique. RESULTS: A comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus. CONCLUSIONS: The modified Delphi technique provides an efficient and rigorous means to reach consensus on topics requiring expert opinion. The AAN Neuro-ID section provided the pool of diverse experts, the infrastructure, and the community through which to accomplish the consensus project successfully. This process could be applied to other subspecialties and sections at the AAN.
Assuntos
Infecções do Sistema Nervoso Central , Currículo , Neurologia/educação , Competência Clínica , Técnica Delphi , HumanosRESUMO
PURPOSE OF REVIEW: Bacterial infections of the central nervous system are neurologic emergencies. Prompt recognition and treatment are essential not only to prevent mortality, but also to decrease neurologic sequelae. This article focuses on the two most common central nervous system bacterial infections, bacterial meningitis and spinal epidural abscess. RECENT FINDINGS: Two outbreaks of serogroup B meningococcal disease have occurred on US college campuses. The meningococcal vaccine given to young adults does not contain serogroup B. SUMMARY: In bacterial meningitis and in bacterial spinal epidural abscess, the identification of and eradication of the pathogen with antimicrobial therapy is the easy part. It is the recognition of the disorder, the understanding of which diagnostic studies to obtain and their limitations, and the management of the neurologic complications that require the expertise of a neurologist.
Assuntos
Infecções Bacterianas do Sistema Nervoso Central , Abscesso Epidural , Meningites Bacterianas , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/terapia , Abscesso Epidural/diagnóstico , Abscesso Epidural/terapia , Humanos , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/terapiaRESUMO
(1-3)-ß-d-Glucan (BDG) from cerebrospinal fluid (CSF) is a promising marker for diagnostic and prognostic aid of central nervous system (CNS) fungal infection, but its relationship to serum values has not been studied. Herein, we detected BDG from CSF at levels 2-fold lower than those in serum in patients without evidence of fungal disease but 25-fold higher than those in in serum in noncryptococcal CNS fungal infections. CSF BDG may be a useful biomarker in the evaluation of fungal CNS disease.
Assuntos
Biomarcadores/líquido cefalorraquidiano , Infecções Fúngicas do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , beta-Glucanas/líquido cefalorraquidiano , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteoglicanas , Adulto JovemRESUMO
Encephalitis is an infectious or inflammatory disorder of the brain that presents with fever, headache, and an altered level of consciousness. There may also be focal or multifocal neurologic deficits, and focal or generalized seizure activity. Of the infectious etiologies, herpesviruses are the most common and some of the few treatable viral causative agents of encephalitis. The etiology, clinical presentation, diagnosis, and treatment of viral encephalitis is discussed in this chapter.
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Infecções Bacterianas do Sistema Nervoso Central/terapia , Encefalite Viral/terapia , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/etiologia , Infecções Bacterianas do Sistema Nervoso Central/virologia , Encefalite Viral/diagnóstico , Encefalite Viral/etiologia , Encefalite Viral/virologia , HumanosRESUMO
OBJECTIVE: To review the evidence base for different treatment strategies in intraparenchymal neurocysticercosis in adults and children. METHOD: A literature search of Medline, EMBASE, LILACS, and the Cochrane Database from 1980 to 2008, updated in 2012, resulted in the identification of 10 Class I or Class II trials of cysticidal drugs administered with or without corticosteroids in the treatment of neurocysticercosis. RESULTS: The available data demonstrate that albendazole therapy, administered with or without corticosteroids, is probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis, and is well-tolerated. There is insufficient information to assess the efficacy of praziquantel. RECOMMENDATIONS: Albendazole plus either dexamethasone or prednisolone should be considered for adults and children with neurocysticercosis, both to decrease the number of active lesions on brain imaging studies (Level B) and to reduce long-term seizure frequency (Level B). The evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis (Level U).
Assuntos
Academias e Institutos/normas , Albendazol/uso terapêutico , Anticestoides/uso terapêutico , Medicina Baseada em Evidências , Neurocisticercose/tratamento farmacológico , Neurologia/normas , Ensaios Clínicos como Assunto , Bases de Dados Factuais/estatística & dados numéricos , Diagnóstico por Imagem , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Feminino , Humanos , Masculino , Neurologia/métodosRESUMO
PURPOSE OF REVIEW: The incidence of spinal epidural abscess is increasing, and the understanding of the pathophysiology is evolving. Better understanding of the pathophysiology, specifically the role of ischemia, warrants a change in therapy. RECENT FINDINGS: Paralysis in spinal epidural abscess may be the result of spinal cord compression, spinal cord arterial and/or venous ischemia and thrombophlebitis or a combination of these. SUMMARY: Recent evidence indicates the following areas of investigation and management can improve outcome in spinal epidural abscess: minimally invasive surgery early versus medical management when there are no significant neurological deficits, neuroradiologic arterial evaluation with therapies directed at vascular ischemia and thrombosis, and aggressive rehabilitation.
Assuntos
Abscesso Epidural/cirurgia , Paralisia/etiologia , Compressão da Medula Espinal/cirurgia , Abscesso Epidural/complicações , Humanos , Compressão da Medula Espinal/complicações , Resultado do TratamentoRESUMO
This case series highlights our experience with use of the Fungitell assay for quantifying (1,3)-ß-d-glucan in cerebrospinal fluid during the current U.S. outbreak of fungal meningitis related to contaminated methylprednisolone acetate. This test may prove a useful adjunct in diagnosis and management of exposed patients.
Assuntos
Líquido Cefalorraquidiano/química , Doença Iatrogênica , Meningite Fúngica/diagnóstico , beta-Glucanas/líquido cefalorraquidiano , Adulto , Idoso , Contaminação de Medicamentos , Feminino , Humanos , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Metilprednisolona/análogos & derivados , Acetato de Metilprednisolona , Pessoa de Meia-Idade , ProteoglicanasRESUMO
Pregnancy is associated with impaired T-cell-mediated immunity putting the woman at risk for infectious diseases not typically seen in immunocompetent individuals. When maternal infection is severe, and when a primary herpesvirus infection is acquired during pregnancy, there is a risk of fetal loss, maternal death, neonatal death, or congenital abnormalities from intrauterine infection. In this review, the authors emphasize specific neurologic infectious diseases that occur in pregnancy, the safety of the antimicrobial therapy of these diseases during pregnancy, as well as the congenital and neonatal sequelae of infection.
Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/prevenção & controle , Humanos , Gravidez , Diagnóstico Pré-Natal/métodos , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/prevenção & controleRESUMO
Any of a number of neuroinfectious diseases can cause a disorder of consciousness. The priority in the care of the patient is to identify an infectious disease that is treatable. This article examines disorders of consciousness that may be caused by a septic encephalopathy, bacterial meningoencephalitis, viral encephalitis, tick-borne bacterial disease, fungal meningitis, tuberculous meningitis, a focal infectious mass lesion, such as a brain abscess, or an autoimmune-mediated disorder as a complication of infection.
Assuntos
Doenças Transmissíveis/complicações , Transtornos da Consciência/etiologia , Doenças Transmissíveis/classificação , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/terapia , Diagnóstico Diferencial , HumanosRESUMO
PURPOSE OF REVIEW: : Neurologists have a vital role in the recognition of meningitis and encephalitis, the accurate evaluation and interpretation of CSF studies, and the management and prevention of the neurologic complications of CNS infectious diseases. RECENT FINDINGS: ;: Although the tetravalent meningococcal glycoconjugate vaccine has decreased the incidence of meningococcal meningitis, the vaccine does not contain serogroup B, which is responsible for one-third of cases of meningococcal disease. Thus, meningitis due to Neisseria meningitidis is still a concern in a vaccinated individual. Empiric therapy for meningitis associated with sinusitis, otitis, or mastoiditis should include antibiotic therapy for anaerobes. An organism that classically causes a subacute or chronic meningitis, such as Mycobacterium tuberculosis, may on occasion present with an acute onset of symptoms. SUMMARY: ;: Unlike most other diseases, the management of patients with suspected meningitis or encephalitis begins with empiric therapy. The etiologic organism cannot always be identified. The goal is to identify those that are treatable, provide supportive care for those that are not, and, when possible, prevent the neurologic complications of these infections.