Japanese

Title	脳炎・髄膜炎の病態と治療
Subtitle	特集 / メディカルスタッフレクチャー9
Authors	中嶋秀人**
Authors (kana)
Organization	**日本大学医学部内科学系神経内科学分野
Journal	神経治療学
Volume	36
Number	4
Page	399-402
Year/Month	2019 /
Article	報告
Publisher	日本神経治療学会
Abstract	「はじめに」 脳炎・髄膜炎は中枢神経系に炎症をきたした病態であり, 原因は細菌, ウイルス, 結核, 真菌など感染症のほか自己免疫性脳炎や傍腫瘍症候群など多岐にわたる. 脳炎・髄膜炎では治療開始の遅れが重度後遺症や致死的転帰を招くためneurological emergencyとして対応する. そのため, 脳炎・髄膜炎が疑われれば確定診断がつかなくとも推測される病原体に対する治療を開始する必要があり, 年齢, 基礎疾患, 病歴, 発症様式の確認は原因を推測するうえで重要である. 診療ガイドラインでは, 細菌性髄膜炎では受診から抗菌薬開始までの時間は「1時間以内」, 単純ヘルペス脳炎では受診からaciclovir開始までの時間は「6時間以内」が望ましいとされる. 本稿では細菌性髄膜炎, 結核性髄膜炎, クリプトコッカス髄膜炎, 単純ヘルペス脳炎, 抗NMDA受容体脳炎をとり上げ, 脳炎・髄膜炎の診療マネージメントについて述べる.
Practice	臨床医学：内科系
Keywords	bacterial meningitis, tuberculous meningitis, cryptococcal meningitis, herpes encephalitis, anti-NMDAR encephalitis

English

Title	Diagnosis and treatment of encephalitis/meningitis
Subtitle
Authors	Hideto NAKAJIMA
Authors (kana)
Organization	Division of Neurology, Department of Medicine, Nihon University School of Medicine
Journal	Neurological Therapeutics
Volume	36
Number	4
Page	399-402
Year/Month	2019 /
Article	Report
Publisher	Japanese Society of Neurological Therapeutics
Abstract	Encephalitis and meningitis are severe neurological infections, and the neurologic manifestations of these conditions include fever, headache, altered mental status, convulsions, and psychiatric symptoms. It is critical that the clinician considers a broad range of causes, such as bacteria, virus, tuberculosis, fungus, and autoimmune or paraneoplastic diseases. Since treatment is more efficient if given early, these conditions of encephalitis/meningitis should represent as a life-threatening neurological emergency. For patients with suspected encephalitis/meningitis, therefore, empiric treatments should be initiated promptly based on the history, physical examination, and cerebrospinal fluid (CSF) findings. In this article, the author describes the characteristic clinical findings, magnetic resonance imaging and spinal fluid analysis of bacterial meningitis, tuberculous meningitis, cryptococcal meningitis, herpes simplex encephalitis, and anti-NMDA receptor encephalitis, and discusses the choice of empirical treatments until the cause of infection is determined. Also the differential diagnosis of encephalitis/meningitis is reviewed, with an emphasis on infectious etiologies.
Practice	Clinical internal medicine
Keywords	bacterial meningitis, tuberculous meningitis, cryptococcal meningitis, herpes encephalitis, anti-NMDAR encephalitis

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