Herpes zoster can involve the central nervous system, presenting as encephalitis, meningitis, or combined meningoencephalitis. These presentations require specific inpatient management and prompt initiation of targeted therapy.
This protocol addresses herpes zoster encephalitis or meningitis (meningoencephalitis) — CNS manifestations that carry significant morbidity and demand a treatment approach distinct from uncomplicated zoster.
Both encephalitis and meningitis presentations are managed with intravenous antiviral therapy; complete regimen details, treatment duration, and guidance on adjunctive agents are specified in the full protocol.
The primary target is clinical improvement of encephalitis. Patients with manifest encephalitis require close monitoring in an intermediate or intensive care setting until improvement is achieved.
DOI: 10.1111/ddg.14013
Both encephalitis and meningitis should be treated with intravenous acyclovir for 10–14 days.
Additional administration of corticosteroids is not useful, as there are no studies that provide evidence for their effectiveness.
Manifest encephalitis requires that patients be closely monitored in an intermediate or intensive care unit until there is clinical improvement.
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