Viral infection

Dr. Steven, M.Si.Med, Sp.S

General principles
n Invasion of the nervous system may occur as
part of a generalised viral infection

n Viruses enter the body throught the:

- respiratory tract
- gastrointestinal tract
- genitourinary tract
- inoculation throught the skin
 Massive viraemia Invades CNS via
capillaries and veins

Overcomes
Routes of monocyte and
Spread to reticuloendothelial
CNS defence system

Infection along Invades CNS

peripheral nerves
Viral Meningitis
n Aseptic meningitis
n Common causal viruses
ENTEROVIRUSES
MUMPS VIRUS
HERPES SIMPLEX (subtype 2)
EPSTEIN-BAR VIRUS (EBV)
n Rare causal viruses
LYMPHOCYTIC CHORIOMENINGITIS
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
 Clinical features

PRODROMAL PHASE MENINGIAL PHASE

Fever Headache RECOVERY
Malaise Photophobi a 7-14 days
Sore throat Drowsiness

SIGNS:
COMPLICATIONS:
Mild meningism Skin rashes
Febrile seizures
Neck stiffness Parotitis
Inappropri ate ADH
Kernig`s sign + Diarrhoea
secretion
No focal sign Myalgia
Investigations
n CSF cell count is elevated (lymphocytes or
monocytes)
n Normal glucose and prot ein
n PCR viral DNA/RNA

Treatment symptomatic
Prognosis is excellent
Acute Viral Encephalitis
n Viruses may act :
directly acute viral encephalitis or
meningoencephalit is
indirectly via the immune system allergic
or postinfectious encephalomyelit is
and postvaccinial encephalomyelit is
n Causes neuronal and glial damage +
inflammation and oedema
n Common causal viruses:
- Mumps
- Herpes simplex
- Varicella zost er
- Epstein-Barr
- Arboviruses
n Encephalitis following childhood inf ection
(Measles, varicella, rubella) is presumed to be
postinfectious and not due to direct viral invasion
 Clinical features
n Sign and symptoms :
- pyrexia, myalgia, etc
- Sign and sympt oms of parenchymal involvement
(focal and or diffuse)
 Coma, confusion, dysphasia,
Cerebrum hemiparesis, involuntary
movements and seizures

Midbrain Oculomotor palsy, autonomic

disturbance

Cerebellum Dysarthria, ataxia

Brain stem Cranial nerve palsies,

nystagmus, tetraparesis

Spinal cord Autonomic, motor, sensory

dysfunction
Treatment

n Illness lasts for some weeks

n Symtomatic therapy
n Herpes simplex and Varicella zost er acyclovir
30mg/kg/day divided 3 dosages

Prognosis is uncertain and depend on the causal

virus as do neurological sequelae