Post infectious CNS disorders: towards a unified approach

Abstract

The spectrum of post infectious (PI) central nervous system (CNS) conditions includes a range of grey and white-matter disorders which can occur after viral or bacterial infections or in response to vaccinations. The clinical, radiological and immunological phenomenology raises a number of issues regarding the nature of immune-mediated CNS abnormalities, their etiology, pathogenesis and therapy. Here we focus on crucial issues pertaining to pathogenesis and aim to identify where current knowledge is insufficient in order to suggest future avenues of clinical and experimental research that may help to devise optimal therapy for these conditions.

Post-infectious headache: a reactive headache?

“…Vanast [18], in 1987, suggested autoimmune disorder with a persistent viral trigger for chronic benign daily headache (NDPH). Tissue specificity is a general feature of post-infectious immune-mediated conditions [4]. Our case series and review of the literature, especially Almazov and Brand [8] observations, and Li and Rozen’s [9] case series, suggest that meningeal involvement may the primary site for the generation of post-infectious headache.…”

“…Post-infectious disorders usually start after an active infection [4]. The distinction of infectious from post-infectious process is important as infectious process depends on the continued presence of viable microorganisms and should be treated with antimicrobial therapy, while post-infectious process ought to be blocked by inhibition of the involved host process [4]. …”

“…Favorable response to immunotherapy is one of the indirect evidences to consider a disease as a post-infectious disorder [4]. Most post-infectious disorders show a response to steroids and other immunosuppressive drugs.…”

“…However, post-infectious disorder is usually described when symptoms and signs develop following recovery from an infection elsewhere in the body [4]. Various post-infectious neurological and non neurological disorders [acute disseminated encephalomyelitis (ADEM), chronic fatigue syndrome] may have headache as one of the accompanying symptoms.…”

Unusual and benign course of idiopathic facial diplegia

“…4 In most instances ''facial diplegia'' occurs either as a bilateral Bell's palsy or in the context of Guillain-Barré syndrome (GBS). 6 In the last year we have observed four patients with acute facial diplegia with a similar clinical presentation. Facial diplegia was accompanied with mild meningitis and no clinical or electrophysiological evidence for GBS.…”