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Encephalitis
Encephalitis
Encephalitis, Emedicine.com
Primary encephalitis
Post - infectious or Para - infectious
encephalitis
Virus
Arbovirus : JEV & Dengue virus
Herpes virus (simplex , zoster)
Enteroviruses including coxsackie
infected by feeding on
domestic pigs and wild
birds infected with
Japanese encephalitis
virus
Infected mosquitoes
transmit virus to humans
and animals during the
feeding process
Encephalitis
Japanese Encephalitis
Bacteria
H. influenza
S. pneumoniae
N. meningitidis
M. tuberculosis
Mycoplasma pneumoniae
Others
Rickettsia, Spirochete & Malaria
A text book of Infectious disease I,
Measles
1: 2,000,000 dose , 6-15 day after
injection
Initial Signs
Fever
Headache
Malaise
Anorexia
Nausea and Vomiting
Abdominal pain
Encephalitis, Emedicine.com
Developing Signs
Altered LOC mild lethargy to deep coma
AMS confused, delirious, disoriented
Mental aberrations :
hallucinations
personality change
behavioral disorders ; occasionally frank psychosis
cases.
Severe focused neurologic deficits
Encephalitis, Emedicine.com
Neurologic Signs
Most Common
Aphasia
Ataxia
Hemiparesis with hyperactive tendon
reflexes
Involuntary movements
Cranial nerve deficits (ocular palsies, facial
weakness)
Encephalitis, Emedicine.com
Patient History
Physical exam
Work up
disease
infectious diseases
Season
Japanese encephalitis : rainy season
Arbovirus infections are : summer and fall
Predisposing factors :
Immunosuppression caused by disease and/or
drug treatment
Organ transplant Opportunistic infections
HIV CNS infections
HSV-2 encephalitis and CMV infection
Lumbar puncture
CSF examination (Polymorphonuclear cells
Viral culture
Viral PCR may identify the virus
Serology tests antibodies to an specific
virus JEV, Dengue, Mycoplasma (4
fold rising )
A text book of Infectious disease I,
NB
-Term
-Preterm
Infant &
child
WBC/
mm3
Protein
(mg/dl)
CSF / blood
glucose
(%)
0-32
0-29
20-170
65-150
44-248
55-105
0-6
15-45
60-90
WBC
pressure
Bacteri
a
Virus
TB
N,
N
pandy
No.
++ -
Trac
-
e
+++ -
Chemistry
Stain
Type
glu
prot
gram
AFB
PMN
L
L
L
N
L
N,
+
-
Metabolic causes
Drug & Toxicology
Mass lesion
Epilepsy
Subarachnoid hemorrhage
Acute confusional migraine
Autoimmune : SLE
CNS Vasculitis
A text book of Infectious disease I,
Fever
Headache
AMS
Focal Neurologic Signs
Types of seizures
Blood: Leukocytosis
CSF: Pleocytosis
EEG: Diffuse slowing
MRI
Encephalopathy
Uncommon
Uncommon
Steady deterioration
Uncommon
Generalized
Uncommon
Uncommon
Common
Often normal
Encephalitis
Common
Common
May fluctuate
Common
Both
Common
Common
+Focal
Focal Abn.
Encephalitis, Emedicine.com
Specific treatment
HSV encephalitis : Neonate & infant
Supportive treatment
Reduce intracranial pressure : restrict
Current practice in
common Infectious
disease 2005