Reviews and Selected Updates References

The diagnosis and therapy of central nervous system (CNS) viral infections is one of the most rapidly evolving and exciting areas in neurology. Viruses gain access to the CNS either through the bloodstream or through an intraneuronal route from the peripheral nerves. Viruses may cause acute CNS disease such as meningitis or encephalitis, a delayed complication of an acute infection such as postinfectious polyneuritis or autoimmune encephalomyelitis, latent infections with recurrence of disease from time to time, or slowly progressive neurological disorders. The important human nervous system viruses are listed in T§.b.!e 41:i . The most common acute CNS viral infections are meningitis and encephalitis. The classic clinical presentation of viral meningitis includes fever, headache, photophobia, myalgias, and nausea and vomiting. There is no alteration in the level of consciousness. The viral etiological agents of meningitis are listed in Táble^ii?, , and XabJeii-^ lists a differential diagnosis of aseptic meningitis. Viral encephalitis is characterized by fever, an altered level of consciousness, headache, and seizure activity. The etiological agents of viral encephalitis are listed in Table...4.1-4 . In addition, viral encephalitis may present as a focal encephalitis with focal neurological deficits and focal seizure activity. The etiological agents of focal encephalitis are listed in Table..41-4 .

In addition to meningitis and encephalitis, CNS enteroviral infections may present as an acute transverse myelitis (characterized by abrupt onset of weakness of the limbs progressing to flaccid paralysis in association with a sensory level), single or multiple limb paralysis (polio), cerebellar ataxia (a common presentation of enteroviral CNS infection in children), a chronic meningoencephalitis ( ..Ta.b.!.e...4..1.,.-.§ ), or a postinfectious polyneuritis. Measles and rubella viruses can cause a slowly progressive neurological disease that presents several years after the acute viral illness has occurred. Other viruses such as the human T-cell lymphotrophic virus type 1 (HTLV-1) can cause a slowly progressive neuromyelopathy in adulthood with no prior history of apparent infection. Human herpesviruses, herpes simplex virus and varicella-zoster virus, are the prototypical viruses that establish lifelong latent infections in human peripheral and CNS sensory ganglia that may episodically reactivate, resulting in acute infection. This chapter reviews the epidemiology, pathogenesis, clinical features, diagnosis, and management of the human nervous system viruses listed in iT§ble...41.-i .

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Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

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