PEDIATRIC ENCEPHALITIS

Rifngatun Nadhiroh, S.Ked

Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad
 DEFINITION
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad
 Encephalitis is an inflammation of the brain
parenchyma, and may be caused by infections or
autoimmune conditions.

 Diagnosis is typically made by a combination of clinical,

laboratory, neuroimaging, and electrophysiologic
findings.

 Computed Tomography (CT), Magnetic Resonance

Imaging (MRI) is recommended for patients with
encephalitis.
 EPIDEMIOLOGY
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad
 Overall, there were 7.3 encephalitis cases per 100,000
person in the US years during 2000– 2010 with peak
incidence in infants <1 year (13.5 per 100,000) and
lowest in children 10– 14 years (4.1 per 100,000).

 In Indonesia, encephalitis was first reported in 1996.

95% occur in children under 10 years.
 PATHOGENS
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad
 PATHOGENESIS
Local : viruses are limited to infecting certain surface
Rifngatun mucous
Nadhiroh, S.Ked
membranes or organ. Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad

Primary hematogenous spread: the virus enters the blood and

then spreads to organ and multiply in these organ.

Secondary hematogenous spread: the virus multiply in the

area first enters (mucous membrane surface) then spreads to
other organs.

Spread through nerves: viruses multiply on the surface of the

muvous membranes and spread through the nervous system.
 CLINICAL MANIFESTATIONS
Rifngatun Nadhiroh, S.Ked
•Dosen
Fever Pembimbing
≥38°C : dr. P. Tigor Yeheskiel, Sp. Rad • Loss of
within 72 conciousness
International Encephalitis Consortium • Seizures (focal
(IEC) hours
or general)
CRITERIA DIAGNOSIS
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad

American Academy of Neurology

 DIAGNOSE
Encephalitis can be diagnosed by clinical manifestation and
Rifngatun
neuroimaging with Nadhiroh,
CT scan andS.Ked
MRI
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad

Leptomeningeal enhancement
 DIFFERENTIAL DIAGNOSIS
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad

Cerebral abses Cerebral infark

 DISCUSSION
Rifngatun Nadhiroh, S.Ked
 A 3-year-old men complained of seizure since the age of 1 years, complaints
0
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad
accompanied by fever (>39 C), then seizures occur with a frequency of 1-2 minutes
with a resting phase in each spasm.

 Seizures usually occur 2-3 times a week. Besides the central nervous system disorders
in the form of muscle weakness so that the patient is slow to walk and imbalance in
motor movements or ataxia.

 Then, patient comes to the radiology department and undergoes contrast MSCT
examination.
DISCUSSION
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad

Multi Slice Computed

Tomography (MSCT)
head with contrast
Leptomeningeal
enhancement
 DISCUSSION
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad

 In this case, the patient feel a similar complaint, seizure experienced by patient arise
from the age 1 years, with fever (>390C), disorientation, deficit neurologist and from
physical examination, no abnormaitas were found, this can occur because the patient
condition is not possible, meningeal sign negative. CT Scan revealed a leptomeningeal
enhancement picture.
 DISCUSSION
Rifngatun Nadhiroh, S.Ked
Clinical Manifestation Examination
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad:
Neuroimaging

Based on patient complaints, the clinical

picture and radiological examination
support that this encephalitis.
 COMPLICATION
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad
 Brain swelling can cause permanent brain damage
 Learning difficulties
 Speech problems
 Memory loss
 Increased intracranial pressure
 Cerebral infarction
 PROGNOSIS
Rifngatun Nadhiroh, S.Ked
 The prognosis of viral encephalitis
DosenisPembimbing
very poor: dr.
inP.untreated patient.
Tigor Yeheskiel, Sp. Rad

 Viral encephalitis death reaches 70-80% after 30 day and rises to 90% in 6 months.

 Early treatment with acyclovir will reduce mortality to 28%. Sequelae is more
frequent and more severe in untreated patients.
 CONCLUSION
Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad
 Encephalitis results from inflammation of the brain parenchyma.

 The basic diagnosis of encephalitis is based on clinical manifestations and CT Scan

which produces a picture of leptomeningeal enhancement.
 REFERENCES
1. Venkatesan A, Geocadin R. Diagnosis and Management Rifngatun Nadhiroh,
of AcuteS.Ked
Encephalitis: A Practical Approach
Neurology: Clinical Practice. 2014;4(3):206-215.
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as:
Infect Dis Clin North Am . 2018 March ; 32(1): 145–162. doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United
States, 2011–2014: Original Studies. The Pediatric Infectious Disease Journal • Volume 38, Number 1,
January 2019.
4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver
Agreement: Clinical Radiology. 2016.
5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The
California Encephalitis Project: Pediatric Neurology 52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated
information and services, is located on the world wide web at:
http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Rifngatun Nadhiroh, S.Ked
Dosen Pembimbing : dr. P. Tigor Yeheskiel, Sp. Rad

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