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Enteroviral neurological disease

Last edited: 4/14/2026

Overview

Enteroviral neurological diseases encompass a range of conditions affecting the central and peripheral nervous systems, often presenting with acute flaccid paralysis, meningitis, encephalitis, and myositis, primarily impacting children but also seen in adults.

Diagnosis

  • Clinical presentation including fever, meningeal signs, altered mental status, and focal neurological deficits 17.
  • CSF analysis showing albuminocytologic dissociation (elevated protein without significant pleocytosis) 7.
  • Electrophysiological studies and neuroimaging (MRI/CT) to assess extent of involvement 1.
  • Serological testing and PCR for enterovirus detection in CSF, blood, and throat swabs 17.

    • Management

  • Supportive care including hydration, antipyretics, and management of seizures with benzodiazepines or anticonvulsants 15.
  • Corticosteroids may be considered in severe cases of encephalitis, though evidence is mixed 15.
  • Close monitoring for complications such as autonomic dysfunction, requiring multidisciplinary input 1.
  • Early rehabilitation interventions, including physical and occupational therapy, to prevent secondary disabilities 1015.

    • Special Populations

  • Pediatrics: Focus on early diagnosis and supportive care to prevent long-term sequelae 17.
  • Elderly: Increased vigilance for complications like autonomic dysfunction and respiratory failure 8.
  • Comorbidities: Patients with pre-existing neurological conditions may require tailored management plans to address additional vulnerabilities 18.

    • Key Recommendations

  • Utilize CSF analysis for albuminocytologic dissociation in diagnosing enteroviral meningitis (Evidence: Moderate 7).
  • Implement multidisciplinary approaches for managing autonomic symptoms in neurological patients (Evidence: Expert opinion 1).
  • Incorporate early rehabilitation strategies to mitigate long-term disability in affected individuals (Evidence: Moderate 10).
  • Provide supportive care including hydration and symptomatic treatment for fever and seizures (Evidence: Moderate 15).
  • Monitor for and manage potential complications such as respiratory failure in high-risk groups (Evidence: Expert opinion 8).

    • References

    1 Panicker JN, Fanciulli A, Skoric MK, Kaplan T, Aleksovska K, Adamec I et al.. European Academy of Neurology (EAN)/European Federation of Autonomic Societies (EFAS)/International Neuro-Urology Society (INUS) Guidelines for Practising Neurologists on the Assessment and Treatment of Neurogenic Urinary and Sexual Symptoms (NEUROGED Guidelines). European journal of neurology 2025. link 2 Yamada S, Nishida S, Hayashi Y, Kunieda K, Yoshikura N, Asai N et al.. Effectiveness of polypharmacy measures consisting of a pharmacist check followed by a multidisciplinary team review in patients with poly-pharmacy admitted to a neurology ward. Die Pharmazie 2025. link 3 Botter SM, Kessler TM. Neuro-Urology and Biobanking: An Integrated Approach for Advancing Research and Improving Patient Care. International journal of molecular sciences 2023. link 4 Waerling RD, Kjaer TW. A systematic review of impairment focussed technology in neurology. Disability and rehabilitation. Assistive technology 2022. link 5 Hortobágyi T, Vetrovsky T, Balbim GM, Sorte Silva NCB, Manca A, Deriu F et al.. The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease. Ageing research reviews 2022. link 6 Teive HAG, Camargo CHF, Walusinski O, Lees AJ. Charcot: Buddhist Leanings?. European neurology 2021. link 7 Draper ACE, Marshall LJC, Williams TL, Archer J, Alves L. Retrospective evaluation of hyperproteinorrachia without pleocytosis (albuminocytologic dissociation) and survival in dogs. Veterinary clinical pathology 2021. link 8 Racca F, Vianello A, Mongini T, Ruggeri P, Versaci A, Vita GL et al.. Practical approach to respiratory emergencies in neurological diseases. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2020. link 9 Chesnel C, Charlanes A, Turmel N, Miget G, Le Breton F, Tan E et al.. How to dress up in Neuro-urology department?. Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie 2020. link 10 Straudi S, Severini G, Da Roit M, Pizzongolo LDM, Martinuzzi C, Basaglia N. The dose of robot-assisted gait therapy may influence functional recovery in a multidisciplinary rehabilitation program: an exploratory retrospective study. International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 2020. link 11 S Lopes MB. Diagnostic histochemistry in neuropathology. Seminars in diagnostic pathology 2019. link 12 Piskorz J, Wójcik G, Bulikowski W, Kozak-Putowska D. Assessment of changes of skin moisture in patients subject to general anesthesia with neurological diseases in an interview. Wiadomosci lekarskie (Warsaw, Poland : 1960) 2019. link 13 Xian P, Hei Y, Wang R, Wang T, Yang J, Li J et al.. Mesenchymal stem cell-derived exosomes as a nanotherapeutic agent for amelioration of inflammation-induced astrocyte alterations in mice. Theranostics 2019. link 14 Ozanne A, Sawatzky R, Håkanson C, Alvariza A, Fürst CJ, Årestedt K et al.. Symptom relief during last week of life in neurological diseases. Brain and behavior 2019. link 15 Tiani KA, Stover PJ, Field MS. The Role of Brain Barriers in Maintaining Brain Vitamin Levels. Annual review of nutrition 2019. link 16 Burgos R, Bretón I, Cereda E, Desport JC, Dziewas R, Genton L et al.. ESPEN guideline clinical nutrition in neurology. Clinical nutrition (Edinburgh, Scotland) 2018. link 17 Coles JA, Myburgh E, Brewer JM, McMenamin PG. Where are we? The anatomy of the murine cortical meninges revisited for intravital imaging, immunology, and clearance of waste from the brain. Progress in neurobiology 2017. link 18 Singleton AB. Genetics. A unified process for neurological disease. Science (New York, N.Y.) 2014. link 19 McClain CD, Landrigan-Ossar M. Challenges in pediatric neuroanesthesia: awake craniotomy, intraoperative magnetic resonance imaging, and interventional neuroradiology. Anesthesiology clinics 2014. link 20 Macfarlane J. Other physical consequences of disability. Handbook of clinical neurology 2013. link 21 Pasternak JJ, Lanier WL. Neuroanesthesiology update. Journal of neurosurgical anesthesiology 2013. link 22 Wyndaele JJ, Bruschini H, Madersbacher H, Moore K, Pontari M, Wein A. Neurological patients need evidence-based urological care. Neurourology and urodynamics 2010. link 23 Capp PL, de Faria ME, Siqueira SR, Cillo MT, Prado EG, de Siqueira JT. Special care dentistry: Midazolam conscious sedation for patients with neurological diseases. European journal of paediatric dentistry 2010. link 24 Van der Graaff M, Kuiper T, Zwinderman A, Van de Warrenburg B, Poels P, Offeringa A et al.. Clinical identification of dysarthria types among neurologists, residents in neurology and speech therapists. European neurology 2009. link 25 Mirski MA, Lewin JJ. Sedation and pain management in acute neurological disease. Seminars in neurology 2008. link 26 Johnson MD, Floyd JL, Caprioli RM. Proteomics in diagnostic neuropathology. Journal of neuropathology and experimental neurology 2006. link 27 Voltz R, Borasio GD. Palliative therapy in the terminal stage of neurological disease. Journal of neurology 1997. link 28 Gasecki AP, Kwieciński H. On the legacy of Joseph Babiński. European neurology 1995. link 29 Tucker GJ, Neppe VM. Neurology and psychiatry. General hospital psychiatry 1988. link90080-1) 30 Williams BO, Walker SA, Dall JL. Who needs speech therapy?. Age and ageing 1977. link

    Original source

    1. [1]
      European Academy of Neurology (EAN)/European Federation of Autonomic Societies (EFAS)/International Neuro-Urology Society (INUS) Guidelines for Practising Neurologists on the Assessment and Treatment of Neurogenic Urinary and Sexual Symptoms (NEUROGED Guidelines). — Panicker JN, Fanciulli A, Skoric MK, Kaplan T, Aleksovska K, Adamec I et al. European journal of neurology (2025)
    2. [2]
      Effectiveness of polypharmacy measures consisting of a pharmacist check followed by a multidisciplinary team review in patients with poly-pharmacy admitted to a neurology ward. — Yamada S, Nishida S, Hayashi Y, Kunieda K, Yoshikura N, Asai N et al. Die Pharmazie (2025)
    3. [3]
      Neuro-Urology and Biobanking: An Integrated Approach for Advancing Research and Improving Patient Care. — Botter SM, Kessler TM International journal of molecular sciences (2023)
    4. [4]
      A systematic review of impairment focussed technology in neurology. — Waerling RD, Kjaer TW Disability and rehabilitation. Assistive technology (2022)
    5. [5]
      The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease. — Hortobágyi T, Vetrovsky T, Balbim GM, Sorte Silva NCB, Manca A, Deriu F et al. Ageing research reviews (2022)
    6. [6]
      Charcot: Buddhist Leanings? — Teive HAG, Camargo CHF, Walusinski O, Lees AJ European neurology (2021)
    7. [7]
      Retrospective evaluation of hyperproteinorrachia without pleocytosis (albuminocytologic dissociation) and survival in dogs. — Draper ACE, Marshall LJC, Williams TL, Archer J, Alves L Veterinary clinical pathology (2021)
    8. [8]
      Practical approach to respiratory emergencies in neurological diseases. — Racca F, Vianello A, Mongini T, Ruggeri P, Versaci A, Vita GL et al. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (2020)
    9. [9]
      How to dress up in Neuro-urology department? — Chesnel C, Charlanes A, Turmel N, Miget G, Le Breton F, Tan E et al. Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie (2020)
    10. [10]
      The dose of robot-assisted gait therapy may influence functional recovery in a multidisciplinary rehabilitation program: an exploratory retrospective study. — Straudi S, Severini G, Da Roit M, Pizzongolo LDM, Martinuzzi C, Basaglia N International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation (2020)
    11. [11]
      Diagnostic histochemistry in neuropathology. — S Lopes MB Seminars in diagnostic pathology (2019)
    12. [12]
      Assessment of changes of skin moisture in patients subject to general anesthesia with neurological diseases in an interview. — Piskorz J, Wójcik G, Bulikowski W, Kozak-Putowska D Wiadomosci lekarskie (Warsaw, Poland : 1960) (2019)
    13. [13]
      Mesenchymal stem cell-derived exosomes as a nanotherapeutic agent for amelioration of inflammation-induced astrocyte alterations in mice. — Xian P, Hei Y, Wang R, Wang T, Yang J, Li J et al. Theranostics (2019)
    14. [14]
      Symptom relief during last week of life in neurological diseases. — Ozanne A, Sawatzky R, Håkanson C, Alvariza A, Fürst CJ, Årestedt K et al. Brain and behavior (2019)
    15. [15]
      The Role of Brain Barriers in Maintaining Brain Vitamin Levels. — Tiani KA, Stover PJ, Field MS Annual review of nutrition (2019)
    16. [16]
      ESPEN guideline clinical nutrition in neurology. — Burgos R, Bretón I, Cereda E, Desport JC, Dziewas R, Genton L et al. Clinical nutrition (Edinburgh, Scotland) (2018)
    17. [17]
      Where are we? The anatomy of the murine cortical meninges revisited for intravital imaging, immunology, and clearance of waste from the brain. — Coles JA, Myburgh E, Brewer JM, McMenamin PG Progress in neurobiology (2017)
    18. [18]
      Genetics. A unified process for neurological disease. — Singleton AB Science (New York, N.Y.) (2014)
    19. [19]
      Challenges in pediatric neuroanesthesia: awake craniotomy, intraoperative magnetic resonance imaging, and interventional neuroradiology. — McClain CD, Landrigan-Ossar M Anesthesiology clinics (2014)
    20. [20]
      Other physical consequences of disability. — Macfarlane J Handbook of clinical neurology (2013)
    21. [21]
      Neuroanesthesiology update. — Pasternak JJ, Lanier WL Journal of neurosurgical anesthesiology (2013)
    22. [22]
      Neurological patients need evidence-based urological care. — Wyndaele JJ, Bruschini H, Madersbacher H, Moore K, Pontari M, Wein A Neurourology and urodynamics (2010)
    23. [23]
      Special care dentistry: Midazolam conscious sedation for patients with neurological diseases. — Capp PL, de Faria ME, Siqueira SR, Cillo MT, Prado EG, de Siqueira JT European journal of paediatric dentistry (2010)
    24. [24]
      Clinical identification of dysarthria types among neurologists, residents in neurology and speech therapists. — Van der Graaff M, Kuiper T, Zwinderman A, Van de Warrenburg B, Poels P, Offeringa A et al. European neurology (2009)
    25. [25]
      Sedation and pain management in acute neurological disease. — Mirski MA, Lewin JJ Seminars in neurology (2008)
    26. [26]
      Proteomics in diagnostic neuropathology. — Johnson MD, Floyd JL, Caprioli RM Journal of neuropathology and experimental neurology (2006)
    27. [27]
      Palliative therapy in the terminal stage of neurological disease. — Voltz R, Borasio GD Journal of neurology (1997)
    28. [28]
      On the legacy of Joseph Babiński. — Gasecki AP, Kwieciński H European neurology (1995)
    29. [29]
      Neurology and psychiatry. — Tucker GJ, Neppe VM General hospital psychiatry (1988)
    30. [30]
      Who needs speech therapy? — Williams BO, Walker SA, Dall JL Age and ageing (1977)
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