Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
NIHR Health Protection Unit for Emerging and Zoonotic Infection, Liverpool, UK.
Postgrad Med J. 2023 Jul 21;99(1174):815-825. doi: 10.1136/postgradmedj-2022-141812. Epub 2022 Jun 23.
Encephalitis describes inflammation of the brain parenchyma, typically caused by either an infectious agent or through an autoimmune process which may be postinfectious, paraneoplastic or idiopathic. Patients can present with a combination of fever, alterations in behaviour, personality, cognition and consciousness. They may also exhibit focal neurological deficits, seizures, movement disorders and/or autonomic instability. However, it can sometimes present non-specifically, and this combined with its many causes make it a difficult to manage neurological syndrome. Despite improved treatments in some forms of encephalitides, encephalitis remains a global concern due to its high mortality and morbidity. Prompt diagnosis and administration of specific and supportive management options can lead to better outcomes. Over the last decade, research in encephalitis has led to marked developments in the understanding, diagnosis and management of encephalitis. In parallel, the number of autoimmune encephalitis syndromes has rapidly expanded and clinically characteristic syndromes in association with pathogenic autoantibodies have been defined. By focusing on findings presented at the Encephalitis Society's conference in December 2021, this article reviews the causes, clinical manifestations and management of encephalitis and integrate recent advances and challenges of research into encephalitis.
脑炎是指脑实质的炎症,通常由感染因子或自身免疫过程引起,后者可能继发于感染、副肿瘤或特发性。患者可能出现发热、行为、人格、认知和意识改变的组合症状。他们还可能出现局灶性神经功能缺损、癫痫发作、运动障碍和/或自主神经不稳定。然而,脑炎有时表现为非特异性,再加上其众多病因,使其成为一种难以治疗的神经综合征。尽管一些类型的脑炎的治疗有所改善,但由于其高死亡率和发病率,脑炎仍然是一个全球性问题。及时诊断和采用特定的支持性管理方案可以带来更好的结果。在过去十年中,脑炎的研究取得了显著进展,加深了对脑炎的理解、诊断和管理。与此同时,自身免疫性脑炎综合征的数量迅速增加,与致病性自身抗体相关的临床特征性综合征已得到明确界定。本文通过重点介绍 2021 年 12 月脑炎学会会议上提出的研究结果,综述了脑炎的病因、临床表现和治疗方法,并整合了脑炎研究的最新进展和挑战。