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Encephalitis (Clinical Presentation (Begins with features of viral…
Encephalitis
Clinical Presentation
Begins with features of viral infection - fever, headaches, myalgia, fatigue and nausea
Progresses to personality & behavioural changes, decreased consciousness, confusion, drowsiness, focal neurological deficit, seizures, raised ICP, coma
Triad: fever + headache + altered mental state
May have signs of meningitis - this is known as meaning-encephalitis which consists of inflammation of meninges and brain parenchyma
Insidious onset (days) or can be abrupt
May be travel history or animal bite
WHOLE BRAIN AFFECTED - problems with consciousness (global defect in higher functioning as well as drowsiness etc.) compared to meningitis
Diagnosis
Electroencephalography - shows periodic sharp and slow waves complexes
Lumbar puncture - CSF shows elevated lymphocyte count
MRI - shows areas of inflammation and swelling, generally in the temporal lobes in HSV, may be midline shifting due to raised ICP
Blood and CSF serology is usually helpful
Differential Diagnosis
Stroke
Brain tumour
Meningitis
Treatment
Anti-seizure medication e.g. primidone
If meningitis is suspected then EMERGENCY IM BENZYLPENICILLIN
If viral then immediate treatment with anti-viral - even before the investigation results are available
Epidemiology
Infections are most frequent in children & elderly - mainly viral cause
More common in immunocompromised
Aetiology
Mainly viral - herpes simplex virus, varicella zoster, Epstein Barr, cytomegalovirus, HIV, mumps, measles
Non-viral - bacterial meningitis, TB, malaria
Risk Factors
Extremes of age
Immunocompromised
Pathophysiology
Disease which mostly affects the frontal and temporal lobes resulting in decreased consciousness, confusion and focal signs
Infection and inflammation of the brain parenchyma