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Definition

Encephalitis (en-sef-uh-LIE-tis) is inflammation of the


brain. Viral infections are the most common cause of
the condition.
Encephalitis can cause flu-like symptoms, such as a
fever or severe headache. It can also cause confused
thinking, seizures, or problems with senses or
movement. However, many cases of encephalitis result
in only mild flu-like symptoms or even no symptoms.
Severe cases of encephalitis, while relatively rare, can
be life-threatening. Because the course of any single
case of encephalitis can be unpredictable, it's
important to get a timely diagnosis and treatment.

Symptoms

Most people with viral encephalitis have either no symptoms or mild flu-like symptoms, such as the following:
Headache
Fever
Aches in muscles or joints
Fatigue or weakness
More-serious cases require prompt medical care. Additional signs and symptoms of more serious encephalitis may
include the following:
Confusion, agitation or hallucinations
Seizures
Loss of sensation or paralysis in certain areas of the face or body
Muscle weakness
Double vision
Perception of foul smells, such as burned meat or rotten eggs
Problems with speech or hearing
Loss of consciousness
Signs and symptoms in infants and young children may also include:
Bulging in the soft spots (fontanels) of the skull in infants
Nausea and vomiting
Body stiffness
Inconsolable crying
Poor feeding or not waking for a feeding
Irritability

The exact cause of encephalitis is often unknown, but the most commonly diagnosed cause is a viral infection. Bacterial infections and noninfectious
inflammatory conditions also may cause encephalitis.
An infection may result in one of two conditions affecting the brain:
Primary encephalitis occurs when a virus or other infectious agent directly infects the brain. The infection may be concentrated in one area or
widespread. A primary infection may be a reactivation of a virus that had been inactive (latent) after a previous illness.
Secondary (postinfectious) encephalitis is a faulty immune system reaction in response to an infection elsewhere in the body. Instead of solely
attacking the cells causing an infection, the immune system also mistakenly attacks healthy cells in the brain.
Secondary encephalitis often occurs two to three weeks after the initial infection. Rarely, secondary encephalitis occurs as a complication of a live
virus vaccination.
Common viral causes
Common causes of encephalitis include:
Herpes simplex virus. There are two types of herpes simplex virus (HSV). Either type can cause encephalitis. HSV type 1 (HSV-1) is usually responsible
for cold sores or fever blisters around your mouth, and HSV type 2 (HSV-2) commonly causes genital herpes. Encephalitis caused by HSV-1 is rare, but
it has the potential to cause significant brain damage or death.
Other herpes viruses. Other herpes viruses that may cause encephalitis include the Epstein-Barr virus, which commonly causes infectious
mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.
Enteroviruses. These viruses include the poliovirus and the coxsackievirus, which usually cause an illness with flu-like symptoms, eye inflammation
and abdominal pain.
Mosquito-borne viruses. Arboviruses, or arthropod-borne viruses, are transmitted by mosquitoes or other blood-sucking insects. Mosquito-borne
viruses can cause infections that include West Nile, La Crosse, St. Louis, western equine and eastern equine encephalitis.
Mosquitoes transfer the virus from a nonhuman host such as a bird, chipmunk or horse to humans. Symptoms of an infection may appear
within a few days to a couple of weeks after exposure to an arbovirus.
Tick-borne viruses. The Powassan virus is a well-known tick-transmitted virus that causes encephalitis in the U.S. and Canada. Symptoms usually
appear about a week after exposure to the virus.
Rabies virus. Infection with the rabies virus, which is usually transmitted by a bite from an infected animal, causes a rapid progression to encephalitis
once symptoms begin. Rabies is a rare cause of encephalitis in the U.S.
Childhood infections. Common childhood infections such as measles (rubeola), mumps and German measles (rubella) used to be fairly common
causes of secondary encephalitis. These causes are now rare because of the availability of vaccinations for these diseases.

Risk factors
Anyone can develop encephalitis. Factors that may increase the risk of the
condition include:
Age. Some types of encephalitis are more prevalent or more severe in
certain age groups. In general, young children and older adults are at
greater risk of most types of viral encephalitis. Encephalitis from the
herpes simplex virus tends to be more common in people 20 to 40 years of
age.
Weakened immune system. People who have HIV/AIDS, take immunesuppressing drugs, or have another condition causing a compromised or
weakened immune system are at increased risk of encephalitis.
Geographic regions. Mosquito-borne or tick-borne viruses are common in
particular geographic regions.
Season of the year. Mosquito- and tick-borne diseases tend to be more
prevalent in spring, summer and early fall in many areas of the United
States. In warmer areas of the U.S., however, mosquitoes and ticks may be
present year-round.

Complications

The complications resulting from encephalitis depend on several factors, including


age, the cause of the infection, the severity of the initial illness and the time from
disease onset to treatment.
In most cases, people with relatively mild illness recover within a few weeks with
no long-term complications.
Complications of severe illness
Injury to the brain from inflammation can result in a number of problems. The
most severe cases can result in coma or death.
Other complications varying greatly in severity may persist for months or be
permanent:
Persistent fatigue
Weakness or lack of muscle coordination
Personality changes
Memory problems
Paralysis
Hearing or vision defects
Speech impairments

Tests and diagnosis

Questions about symptoms, risk factors and medical history are important in making a diagnosis of
encephalitis. Diagnostic tests that may be needed include the following:
Brain imaging. Brain imaging is often the first test if symptoms and patient history suggest the
possibility of encephalitis. The images may reveal swelling of the brain or another condition that
may be causing the symptoms, such as a tumor.
Technologies may include magnetic resonance imaging (MRI), which can produce detailed crosssectional and 3-D images of the brain, or computerized tomography (CT), which produces crosssectional images.
Spinal tap (lumbar puncture). With a spinal tap, the doctor inserts a needle into the lower back to
extract cerebrospinal fluid (CSF), the protective fluid that surrounds the brain and spinal column.
Changes in this fluid can indicate infection and inflammation in the brain.
In some cases, samples of CSF can be tested to identify the virus or other infectious agent.
Other lab tests. Samples of blood or urine, or of excretions from the back of the throat can be
tested for viruses or other infectious agents.
Electroencephalogram (EEG). Your doctor may order an EEG, a test in which a series of electrodes
are affixed to the scalp. The EEG records the electrical activity of the brain. Certain abnormal
patterns in this activity may be consistent with a diagnosis of encephalitis.
Brain biopsy. Rarely, a procedure to remove a small sample of brain tissue (brain biopsy) is used if
symptoms are worsening and treatments are having no effect.

Treatments and drugs

Treatment for mild cases, which may be mistaken as the flu, mainly consists of:
Bed rest
Plenty of fluids
Anti-inflammatory drugs such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others) to
relieve headaches and fever.
Antiviral drugs
Cases of encephalitis due to certain viruses usually require intravenous antiviral treatments. Antiviral drugs commonly used to treat encephalitis
include:
Acyclovir (Zovirax)
Ganciclovir (Cytovene)
Foscarnet (Foscavir)
Some viruses, such as insect-borne viruses, don't respond to these treatments. However, because the specific virus may not be identified
immediately or at all, treatment with acyclovir is often begun immediately. This drug can be effective against the herpes simplex virus, which can
result in significant complications, such as encephalitis, or death when not treated promptly.
Side effects of antiviral drugs may include nausea, vomiting, diarrhea, and muscle or joint soreness or pain. Rare serious problems may include
abnormalities in kidney or liver function or suppression of bone marrow activity. Appropriate tests are used to monitor for serious adverse effects.
Supportive care
Additional supportive care also is needed in the hospital for people with severe encephalitis. The care may include:
Breathing assistance, as well as careful monitoring of breathing and heart function
Intravenous fluids to ensure proper hydration and appropriate levels of essential minerals
Anti-inflammatory drugs, such as corticosteroids, to help reduce swelling and pressure within the skull
Anticonvulsant medications, such as phenytoin (Dilantin), to stop or prevent seizures.
Follow-up therapy
After the initial illness, it may be necessary to receive additional therapy depending on the type and severity of complications. This therapy may
include:
Physical therapy to improve strength, flexibility, balance, motor coordination and mobility
Occupational therapy to develop everyday skills and to use adaptive products that help with everyday activities
Speech therapy to relearn muscle control and coordination to produce speech
Psychotherapy to learn coping strategies and new behavioral skills to improve mood disorders or address personality changes with medication
management if necessary

Prevention

The best way to prevent viral encephalitis is to take precautions to avoid exposure to viruses that can cause the disease:
Practice good hygiene. Wash hands frequently and thoroughly with soap and water, particularly after using the toilet and before and after meals.
Don't share utensils. Don't share tableware and beverages.
Teach your children good habits. Teach your children to practice good hygiene and to avoid sharing utensils at home and school.
Get vaccinations. Keep your own and your children's vaccinations current. Before traveling, talk to your doctor about recommended vaccinations for different destinations.
Protection against mosquitoes and ticks
To minimize your exposure to mosquitoes and ticks, follow these tips:
Dress to protect yourself. Wear long-sleeved shirts and long pants if you're outside between dusk and dawn when mosquitoes are most active and when you're in a wooded area with
tall grasses and shrubs where ticks are more common.
Apply mosquito repellent. The Environmental Protection Agency (EPA) has registered a number of products containing certain chemicals that repel mosquitoes. The registered chemicals
are DEET, IR3535, lemon eucalyptus and picaridin. Products with higher concentrations of the active ingredient provide longer protection.
Lemon eucalyptus isn't recommended for use on children younger than 3 years old.
Mosquito repellents can be applied to both the skin and clothes. To apply repellent to your face, spray it on your hands and then wipe it on your face. If you're using both sunscreen and a
repellent, apply sunscreen first.
Use EPA-recommended insecticide. The EPA also recommends the use of products containing permethrin. These products, which repel and kill tics and mosquitoes, are sprayed on
clothing, tents and other outdoor gear. Permethrin shouldn't be applied to the skin.
Avoid mosquitoes. Refrain from unnecessary activity in places where mosquitoes are most prevalent. If possible, avoid being outdoors from dusk till dawn, when mosquitoes are most
active.
Keep mosquitoes out of your home. Repair holes in window and door screens.
Get rid of water sources outside your home. Where possible, eliminate standing water in your yard, where mosquitoes can lay their eggs. Common problems include flowerpots or other
gardening containers, flat roofs, old tires and clogged gutters.
Control mosquitoes in standing water. Fill ornamental pools with mosquito-eating fish. Use mosquito dunks products that are toxic to mosquito larvae in birdbaths, ponds and
garden water barrels.
Look for outdoor signs of viral disease. If you notice sick or dying birds or animals, report your observations to your local health department.
Protection for young children
Insect repellents aren't recommended for use on infants younger than 2 months of age. Instead, cover an infant carrier or stroller with mosquito netting.
Tips for using mosquito repellent with children include the following:
Always assist children with the use of mosquito repellent.
Spray on clothing and exposed skin.
Apply the repellent when outdoors to lessen the risk of inhaling the repellent.
Spray repellent on your hands and then apply it to your child's face. Take care around the eyes and ears.
Don't use repellent on the hands of young children who may put their hands in their mouths.
Wash treated skin with soap and water when you come indoors.