Encephalitis is an inflammation of the

brain
Etiology
Most cases of acute encephalitis are due
to viruses. Most commonly:
a)Herpes simplex virus
b)Arboviruses, and
c)Enteroviruses.
The incidence of encephalitis due to
common childhood infections such as
measles and mumps has declined
significantly with the increased use of
vaccines.
Herpes simplex virus
Causes encephalitis year-round and is
the most common cause of sporadic
acute encephalitis in the United States.
Herpes simplex virus type 2 usually is
the cause of encephalitis in neonates,
whereas herpes simplex virus type 1
causes most cases of encephalitis in
older children.
Arboviruses
Cause encephalitis outbreaks during the
summer, as these viruses are
transmitted by insects (usually
mosquitoes). Important arboviral causes
of encephalitis in the United States
include:
a)California encephalitis virus
b)St. Louis encephalitis virus
c)Eastern equine encephalitis virus
d)Western equine encephalitis virus
Enteroviruses
(e.g coxsackieviruses and echoviruses)
cause encephalitis outbreaks during the
summer.
Viruses associated with childhood
illness
(e.g. mumps, measles, varicella and
rubella) may cause acute or
postinfectious encephalitis.
In postinfectious illness, the encephalitis
is thought to be mediated primarily by
immune mechanisms.
Epstein-Barr virus
Is a rare cause of encephalitis;
occasionally, encephalitis may develop
during infectious mononucleosis.
Nonviral causes of encephalitis
This include mycoplasma pneumonia
and Toxoplasma gondii.
Clinical features of encephalitis vary
widely in severity but most commonly
include the following symptoms.
a)Early signs and symptoms: are
nonspecific and typical of acute
systemic illness (e.g. fever, headache,
vomiting, upper respiratory symptoms)
b)Neurologic signs and symptoms:
develop abruptly. Most commonly
there is a decreased level of
consciousness, which may range from
confusion to deep coma. Seizures,
paralysis, and abnormal reflexes also
are common. Increased intracranial
pressure can result in papilledema.
Diagnosis
A detailed medical history should be
obtained, which should include an
evaluation of all possible exposures to
infected persons, insects, or animals.
In addition, the following laboratory
tests commonly are used to confirm
the diagnosis of encephalitis;
occasionally these tests may reveal a
specific infectious etiology.
a)Lumber puncture and CSF
examination are essential.
1) Typical CSF findings in viral
encephalitis include:
a)Increased intracranial pressure
b)Variable pleocytosis (generally 10-
500 cells/mm)
c)Increased protein level )>40mg/dl)
d)Normal glucose leve
2) In addition, the CSF should be
examined directly for bacteria and
cultured for bacteria, myobacteria,
fungi, and viruses.
b)Brain biopsy: may be performed to
obtain tissue specimens for culture
and rapid viral antigen tests. The
diagnosis of herpes simplex
encephalitis is best confirmed by brain
biopsy
c)Serologic tests
(e.g.hemagglutination inhibition,
complement fixation, (ELISA) may be
used to detect viral antibodies. The
diagnosis of arboviral encephalitis is
best confirmed by serologic test.
d)Eletroencephalograms (EEG) and
computed tomography (CT) and
brain scans my reveal focal or
generalized abnormalities in patients
with encephalitis
Therapy
1.Acyclovir is the drug of choice for
treatment of herpes simplex and
varicella Zoster encephalitis
2.There is no specific therapy for other
types of viral encephalitis.
Supportive care
1.Patients with encephalitis should be
cared for in an intensive care unit,
with close cardiac monitoring and
placement of an intracranial pressure
transducer if intracranial pressure is
moderately to severely increased.
2.Phenobarbital (5 mg/kg/24hr) is given to
prevent convulsion
3.Severe cerebral edema can be
decreased by the following methods:
a)Dexamethasone(0.5mg/kg/24hr)
given intramuscularly
b)Mannitol (1.5-2.0mg/kg/24hr) given
intravenously as a 20% solution
c)Lasix (1-2mg/kg), given intravenously
every 6 hrs