Encephalitis is an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis. Encephalitis is a rare condition.

It occurs more often in the first year of life and decreases with age. The very young and the elderly are more likely to have a severe case. Causes, Incidence, And Risk Factors Encephalitis is most often caused by a viral infection. Many types of viruses may cause it. Exposure to viruses can occur through:

Breathing in respiratory droplets from an infected person Contaminated food or drink Mosquito, tick, and other insect bites Skin contact

Different viruses will occur in different locations. Many cases will tend to cluster in a certain season. Encephalitis caused by the herpes simplex virus is the leading cause of more severe cases in all ages, including newborns. A number of viruses for which there is now a vaccine may also cause encephalitis. These include:

Measles Mumps Polio Rabies Rubella Varicella (chickenpox)

Other viruses that cause encephalitis include:

Adenovirus Coxsackievirus Cytomegalovirus Eastern Equine Encephalitis Virus Echovirus West Nile virus

The virus causes inflammation of brain tissue. The brain tissue swells (cerebral edema), which may destroy nerve cells, cause bleeding in the brain (intracerebral hemorrhage), and brain damage. Symptoms Some patients may have symptoms of a cold or stomach infection before encephalitis symptoms begin. When a case of encephalitis is not very severe, the symptoms may be similar to those of other illnesses, including:

Fever that is not very high Mild headache Low energy and a poor appetite

Other symptoms include:

Clumsiness, unsteady gait Confusion, disorientation Drowsiness Irritability or poor temper control Light sensitivity Stiff neck and back (occasionally) Vomiting

Symptoms in newborns and younger infants may not be as easy to recognize:

Body stiffness Irritability and crying more often (these symptoms may get worse when the baby is picked up) Poor feeding Soft spot on the top of the head may bulge out more Vomiting

Emergency symptoms:

Loss of consciousness, poor responsiveness, stupor, coma Muscle weakness or paralysis Seizures Severe headache Sudden change in mental functions:

"Flat" mood, lack of mood, or mood that is inappropriate for the situation Impaired judgment

Inflexibility, extreme self-centeredness, inability to make a decision, or withdrawal from social interaction Less interest in daily activities Memory loss (amnesia), impaired short-term or long-term memory

Signs and tests An examination may show:

Abnormal reflexes Increased intracranial pressure Mental confusion Mouth ulcers Muscle weakness Neck stiffness Signs in other organs, such as the liver and lungs Skin rash Speech problems

Tests may include:

Brain MRI CT scan of the head Culture of cerebrospinal fluid (CSF), blood, or urine (however, this test is rarely useful) Electroencephalogram (EEG) Lumbar puncture and CSF examination Tests that detect antibodies to a virus (serology tests) Test that detects tiny amounts of virus DNA (polymerase chain reaction -- PCR)

Treatment The goals of treatment are to provide supportive care (rest, nutrition, fluids) to help the body fight the infection, and to relieve symptoms. Reorientation and emotional support for confused or delirious people may be helpful. Medications may include:

Antiviral medications, such as acyclovir (Zovirax) and foscarnet (Foscavir) Antibiotics -- if the infection is caused by certain bacteria Anti-seizure medications (such as phenytoin) -- to prevent seizures Steroids (such as dexamethasone) -- to reduce brain swelling (in rare cases) Sedatives -- to treat irritability or restlessness Acetaminophen -- for fever and headache

Prognosis The outcome varies. Some cases are mild and short, and the person fully recovers. Other cases are severe, and permanent impairment or death is possible. The acute phase normally lasts for 1 - 2 weeks. Fever and symptoms gradually or suddenly disappear. Some people may take several months to fully recover. Complications

Permanent brain damage may occur in severe cases of encephalitis. It can affect: Hearing Memory Muscle control Sensation Speech Vision