Chapter 3 : Viral Central Nervous System Infections

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Viral disease in the central nervous system (CNS) can be classified by pathogenesis. Neurologic disease is frequently categorized as either primary or postinfectious. Primary encephalitis results from direct viral entry into the CNS that produces clinically evident cortical or brain stem dysfunction. Meningitis and encephalitis represent separate clinical entities; however, a continuum exists between these distinct forms of disease. A change in a patient’s clinical condition can reflect disease progression with involvement of different regions of the brain. Epidemiological data in many cases provide clues to the etiology of the illness. Viral meningitis is a relatively benign self-limited illness, and pathological specimens are rarely available for study. The diagnosis of viral meningitis relied on viral culture, and CSF viral culture rates differ based on etiology. The fundamental principle of therapy for viral meningitis lies in the identification of potentially treatable diseases. Similar to the case with viral meningitis, passive reporting systems underestimate the incidence of viral encephalitis. The pathogenesis of encephalitis requires that viruses reach the CNS by hematogenous or neuronal spread. Patients with encephalitis, depending on the etiology and extent of CNS involvement, require treatment tailored to their clinical situation. The approach to a patient with a presumed CNS viral infection must be tailored to the severity and distribution of neurologic involvement. Improvements in ability to diagnose CNS infections will produce a better understanding of the pathogenesis and true extent of CNS viral disease.

Citation: Cassady K, Whitley R. 2009. Viral Central Nervous System Infections, p 29-44. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch3

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Viral Central Nervous System Diseases
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Body surfaces as sites of virus infection and shedding.

Citation: Cassady K, Whitley R. 2009. Viral Central Nervous System Infections, p 29-44. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch3
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Routes of viral invasion of the CNS.

Citation: Cassady K, Whitley R. 2009. Viral Central Nervous System Infections, p 29-44. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch3
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DNA viruses: type of disease, epidemiological data, and pathogenesis of viral infections of the CNS

Citation: Cassady K, Whitley R. 2009. Viral Central Nervous System Infections, p 29-44. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch3
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RNA viruses: type of disease, epidemiological data, and pathogenesis of viral infections of the CNS

Citation: Cassady K, Whitley R. 2009. Viral Central Nervous System Infections, p 29-44. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch3
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Nonviral etiologies for encephalitis and meningitis

Citation: Cassady K, Whitley R. 2009. Viral Central Nervous System Infections, p 29-44. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch3

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