Purpose 

To review the pathologic and clinical features of and establish the frequency of cytomegalovirus encephalitis in adults and to review the methods available for diagnosis and treatment.

Data Source 

MEDLINE search of all English-language articles from January 1965 to August 1995.

Study Selection 

Articles dealing with cytomegalovirus infection of the brain in adults.

We also reviewed all unselected autopsies of these populations to establish the frequency of cytomegalovirus encephalitis in recipients of organ transplants and in patients infected with the human immunodeficiency virus (HIV).

Data Extraction 

Epidemiologic and pathologic characteristics, clinical manifestations, diagnostic methods, pathogenetic mechanisms, and use of anticytomegalovirus treatments.

Data Synthesis 

Of 676 patients receiving a diagnosis of cytomegalovirus encephalitis, 574 (85%) were infected with HIV, 81 (12%) had other causes of immunosuppression, and 21 (3%) were otherwise healthy.

Cytomegalovirus encephalitis was confirmed during autopsy in 12% of HIV-infected patients and 2% of transplant recipients.

The most common lesion was microglial nodule encephalitis, but the clinical findings corresponding to this pathologic entity are not well defined. (...)