Viral encephalitis: Difference between revisions

	Viral encephalitis;
ICD-10	A83-A86, B94.1, G05
ICD-9	323
DiseasesDB	22543
MeSH	D004660

VisualWikitext

Revision as of 22:37, 9 February 2012

For patient information, click here

Template:Encephalitis Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. Sometimes, encephalitis can result from a bacterial infection, such as bacterial meningitis, or it may be a complication of other infectious diseases like rabies (viral) or syphilis (bacterial). Certain parasitic or protozoal infestations, such as toxoplasmosis, malaria, or primary amoebic meningoencephalitis, can also cause encephalitis in people with compromised immune systems. Brain damage occurs as the inflamed brain pushes against the skull, and can lead to death.

History & Symptoms

Patients with encephalitis suffer from fever, headache and photophobia with weakness and seizures are also common. Less commonly, stiffness of the neck can occur with rare cases of patients also suffering from stiffness of the limbs, slowness in movement and clumsiness depending on which specific part of the brain is involved. The symptoms of encephalitis are caused by the brain's defense mechanisms activating to get rid of the infection. Another symptom of Encephalitis is hallucination.

Risk Factors

Encephalitis may be caused by a variety of afflictions. One such affliction is rabies.

Diagnosis

Adult patients with encephalitis present with acute onset of fever, headache, confusion, and sometimes seizures. Younger children or infants may present with irritability, anorexia and fever.

Lab Tests

Neurological examinations usually reveal a drowsy or confused patient. Stiff neck, due to the irritation of the meninges covering the brain, indicates that the patient has either meningitis or meningeoncephalitis. Examination of the cerebrospinal fluid obtained by a lumbar puncture procedure usually reveals increased amounts of protein and white blood cells with normal glucose, though in a significant percentage of patients, the cerebrospinal fluid may be normal. CT scan often is not helpful, as cerebral abscess is uncommon. Cerebral abscess is more common in patients with meningitis than encephalitis. Bleeding is also uncommon except in patients with herpes simplex type 1 encephalitis. Magnetic resonance imaging offers better resolution. In patients with herpes simplex encephalitis, electroencephalograph may show sharp waves in one or both of the temporal lobes. Lumbar puncture procedure is performed only after the possibility of prominent brain swelling is excluded by a CT scan examination. Diagnosis is often made with detection of antibodies against specific viral agent (such as herpes simplex virus) or by polymerase chain reaction that amplifies the RNA or DNA of the virus responsible.

Pathophysiology

Treatment

Medical Therapy

Treatment is usually symptomatic. Reliably tested specific antiviral agents are available only for a few viral agents (e.g. acyclovir for herpes simplex virus) and are used with limited success for most infection except herpes simplex encephalitis. In patients who are very sick, supportive treatment, such as mechanical ventilation, is equally important.

Encephalitis lethargica

Encephalitis lethargica is an atypical form of encephalitis which caused an epidemic from 1917 to 1928. There have only been a small number of isolated cases since, though in recent years a few patients have shown very similar symptoms. The cause is now thought to be either a bacterial agent or an autoimmune response following infection.

Limbic system encephalitis

In a small number of cases, called limbic encephalitis, the pathogens responsible for encephalitis attack primarily the limbic system (a collection of structures at the base of the brain responsible for basic autonomic functions).

@@ Line 17: / Line 17: @@
 {{CMG}}
-==Overview==
+==[[Encephalitis overview|Overview]]==
 '''Encephalitis''' is an [[Acute (medical)|acute]] [[inflammation]] of the [[brain]], commonly caused by a [[virus|viral]] [[infection]]. Sometimes, encephalitis can result from a [[bacteria]]l infection, such as bacterial [[meningitis]], or it may be a complication of other infectious diseases like [[rabies]] (viral) or [[syphilis]] (bacterial). Certain [[parasitic]] or [[protozoa]]l infestations, such as [[toxoplasmosis]], [[malaria]], or [[primary amoebic meningoencephalitis]], can also cause encephalitis in people with [[immune deficiency|compromised]] [[immune system]]s. Brain damage occurs as the inflamed brain pushes against the skull, and can lead to death.
-==Symptoms==
+==[[Encephalitis history and symptoms|History & Symptoms]]==
 Patients with encephalitis suffer from fever, headache and [[photophobia]] with weakness and seizures are also common. Less commonly, stiffness of the neck can occur with rare cases of patients also suffering from stiffness of the limbs, slowness in movement and clumsiness depending on which specific part of the brain is involved. The symptoms of encephalitis are caused by the brain's defense mechanisms activating to get rid of the infection.
 Another symptom of Encephalitis is hallucination.
-==Etiology==
+==[[Encephalitis risk factors|Risk Factors]]==
 Encephalitis may be caused by a variety of afflictions. One such affliction is [[rabies]].
@@ Line 31: / Line 31: @@
 ==Diagnosis==
 Adult patients with encephalitis present with acute onset of fever, headache, confusion, and sometimes seizures. Younger children or infants may present with irritability, anorexia and fever.
+==[[Encephalitis laboratory tests|Lab Tests]]==
 Neurological examinations usually reveal a drowsy or confused patient. Stiff neck, due to the irritation of the meninges covering the brain, indicates that the patient has either meningitis or meningeoncephalitis. Examination of the [[cerebrospinal fluid]] obtained by a [[lumbar puncture]] procedure usually reveals increased amounts of protein and white blood cells with normal glucose, though in a significant percentage of patients, the cerebrospinal fluid may be normal. [[Computed tomography|CT scan]] often is not helpful, as cerebral abscess is uncommon. Cerebral abscess is more common in patients with meningitis  than encephalitis. Bleeding is also uncommon except in patients with [[herpes simplex]] type 1 encephalitis. [[Magnetic resonance imaging]] offers better resolution. In patients with herpes simplex encephalitis, electroencephalograph may show sharp waves in one or both of the temporal lobes. Lumbar puncture procedure is performed only after the possibility of prominent brain swelling is excluded by a CT scan examination. Diagnosis is often made with detection of antibodies against specific viral agent (such as herpes simplex virus) or by [[polymerase chain reaction]] that amplifies the [[RNA]] or [[DNA]] of the virus responsible.
-==Histopathology: Viral encephalitis==
+==[[Encephalitis pathophysiology|Pathophysiology]]==
 <youtube v=F2jB-U3VXp0/>
 ==Treatment==
+==[[Encephalitis medical therapy|Medical Therapy]]==
 Treatment is usually [[symptomatic]]. Reliably tested specific antiviral agents are available only for a few viral agents (e.g. [[acyclovir]] for [[herpes simplex virus]]) and are used with limited success for most infection except herpes simplex encephalitis. In patients who are very sick, supportive treatment, such as mechanical ventilation, is equally important.