• Michael Thy, Augustin Gaudemer, Geoffroy Vellieux, and Romain Sonneville.
• Department of Intensive Care Medicine, AP-HP, Hôpital Bichat - Claude Bernard.
• Curr Opin Crit Care. 2022 Oct 1; 28 (5): 486494486-494.

Purpose Of ReviewMeningitis and encephalitis represent severe neurological syndromes associated with encephalopathy, seizures, focal deficits, and neurological sequelae in survivors. We update on the critical care management of adult patients with severe meningitis and encephalitis.Recent FindingsLarge multicenter studies conducted in the adult population improved current knowledge on the epidemiology and outcomes of patients with severe meningitis and encephalitis. An early multimodal diagnostic workup (including CSF analysis, brain MRI, EEG, and serum studies) is mandatory for diagnosis and prognostication in those patients.New diagnostic methods, including multiplex PCR and next-generation sequencing techniques, allow for a faster differential diagnosis of infectious causes that may require specific antimicrobial therapy. Autoimmune causes of encephalitis, which may require urgent immunotherapy, are also increasingly recognized in the ICU setting. Although observational data suggest that early combined immunotherapy is associated with better neurological outcomes in patients with autoimmune encephalitis, randomized clinical trials have yet to be performed.SummaryOur review highlights the importance of an early multimodal approach for diagnosing severe meningitis and encephalitis. Randomized clinical trials are needed to identify pharmacological interventions that may improve patients' outcomes.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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