Encephalitis

Introduction

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Encephalitis is a very severe infection caused by the inflammation of the brain tissues. When encephalitis occur with meningitis, it is called meningoencephalitis. It is caused either as a direct infection or a sequela of a pre-existing condition. [1]

Causes

Encephalitis is caused by any of the following factors; [2]

  • Viral infection, e.g rabies virus, HSV, poliovirus, mealses virus, bunyavirus, reovirus, etc [3]
  • Bacterial infection, e.g mycoplasma, Lyme disease, Bartonella henselae, malaria, etc can result in encephalitis especially in immuno-compromised individuals.
  • Autoimmune disorders
  • Some types are of unknown aetiology

Clinical Presentation

An adult infected with the disease typically present with; [4]

  • Headache
  • Confusion
  • Fever
  • Drowsiness
  • Fatigue
  • Seizures or convulsions
  • Tremors
  • Stroke
  • Hallucinations
  • Memory problems

An infant may present with; [5]

  • Irritability
  • Poor appetite
  • Fever

Diagnostic Procedures

Encephalitis can be diagnosed using any of the following procedures; [1]

  • Magnetic Resonance Imaging (MRI) to detect the inflammation
  • Electroencephalography (EEG) to monitor the electrical activity of the brain
  • Lumbar puncture (spinal tap)
  • Urine analysis
  • Blood test

Medical Management

These may include; [1]

  1. Antiviral medications (for viral infection)
  2. Antibiotics (for bacterial infection)
  3. Steroids
  4. Sedatives
  5. Acetaminophen

Physiotherapy Management / Interventions

  1. Exercise therapy
  2. Gait rehabilitation
  3. Manual therapy
  4. Passive motion procedures

Differential Diagnosis

  1. Leptospirosis
  2. CNS vasculitis
  3. Meningoencephalitis
  4. Stroke
  5. Meningitis
  6. Subdural empyema
  7. Meningeal carcinomatosis

References

  1. 1.0 1.1 1.2 Kennedy PGE. Viral Encephalitis: Causes, Differential Diagnosis, and Management. Journal of Neurology, Neurosurgery & Psychiatry. 2004;75 (suppl 1): i10–i15
  2. Larner AJ. Neuropsychological Neurology: The Neurocognitive Impairments of Neurological Disorders. 2013. Cambridge University Press.
  3. Fisher DL, Defres S, Solomon T.  Measles-induced encephalitis. QJM. 2015; 108 (3): 177–182.
  4. Jmor F, Emsley HC, Fischer M. et al. The incidence of acute encephalitis syndrome in Western industrialised and tropical countries. Journal of Virology.2008; 5 (134): 134.
  5. Armangue T, Petit-Pedrol M, Dalmau J. Autoimmune Encephalitis in Children. Journal of child neurology. 2012; 27 (11): 1460–1469.