Encephalitis

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Encephalitis is an acute inflammation of the brain.

Encephalitis with meningitis is known as meningoencephalitis.

Symptoms include headache, fever, confusion, drowsiness, and fatigue. More advanced and serious symptoms include seizures/convulsions, tremors, hallucinations, and memory problems.

Contents

Cause

Viral

Viral encephalitis can be due either to the direct effects of an acute infection, or as one of the sequelae of a latent infection. A common cause of encephalitis in humans is herpes simplex virus type I (HSE) which may cause inflammation of the brain. This can result to death. Others include infection by Flaviviruses such as St. Louis encephalitis or West Nile virus, or Togaviruses such as Eastern equine encephalitis (EEE), Western equine encephalitis (WEE) and Venezualen equine encephalitis (VEE).

Bacterial and other

It can be caused by a bacterial infection, such as bacterial meningitis, spreading directly to the brain (primary encephalitis), or may be a complication of a current infectious disease syphilis (secondary encephalitis). Certain parasitic or protozoal infestations, such as toxoplasmosis, malaria, or primary amoebic meningoencephalitis, can also cause encephalitis in people with compromised immune systems. Lyme disease and/or Bartonella henselae may also cause encephalitis.

Another cause is granulomatous amoebic encephalitis.

Diagnosis

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

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 meningoncephalitis. 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 in the cerebrospinal fluid against a specific viral agent (such as herpes simplex virus) or by polymerase chain reaction that amplifies the RNA or DNA of the virus responsible (such as varicella zoster virus).

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