A Family Doctor's Tale - ENCEPHALITIS

DOC I HAVE ENCEPHALITIS

Encephalitis is a serious medical disease which causes inflammation and infection of the brain.

The causes of Encephalitis may be divided into:

Infections:
1.viral infections are the most common
(herpes simplex virus, mumps, measles, rubella, chickenpox, West Nile Encephalitis, Japanese Encephalitis, St Lious Encephalitis).

Of these viruses, herpes simplex virus is the most serious and can cause fatality.

2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus(Streptococcus pneumoniae) can be serious and fatal in some cases.

Meningococcal Encephalitis can cause outbreaks(spread easily).

3.fungi,
Cryptococcus neoformans is the most common cause of fungal Encephalitis

4.Parasitic
Examples are Toxoplasmosis, malaria, amoeba, Lyme Disease

The symptoms which often defines Encephalitis are:

1.Severe headache

2.Fever

3.Irritabilty

4.Confusion

5.Drowsiness and fatigue

Other symptoms are:

6.seizures and convulsions

7.vomiting

8.hallucinations

9.memory problems

10.tremors

11.weakness of the hands and legs

12.incontinence of urinary and bowel movement

The diagnosis of Encephalitis is made by:
1.Typical symptoms of fever, headache, confusion .

2.Physical examination shows confusion ,drowsiness and signs of neck rigidity

3.blood tests (complete blood count, ESR and blood culture)

4.cerebrospinal fluid analysis (CSF) via lumbar puncture is examined for increased white blood cells and protein content,  normal glucose level. Red blood cells may be present if there is bleeding. Sometimes the CSF may show the presence of micro-organisms.

This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs, or signs of raised ICP).

5.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.

The complications of Encephalitis are:
1.Neurological deficits

2.deafness

3.learning disorders in children

4.brain infarction,

5.septic shock,

6.adult respiratory distress syndrome

7.seizures also more in children

8.pneumonia especially in the elderly

The treatment of Encephalitis is:
1.Hospitalisation should be immediate as Encephalitis can be a life threatening condition.

2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.

Acyclovir may be given for herpes virus infection

High dosages of antifungals may be given for Fungal Encephalitis for a prolonged period of time

3.corticosteroids is useful to reduce swelling and inflammation in the brain

4.Sedatives may be needed for irritabilty and restlessness

5.High-flow oxygen

6.intravenous fluids

The prognosis of Encephalitis is:
This depends on the severity and type of infection.

Viral infections except for herpes simplex usually recover quickly.

Bacterial infections such as meningococcus and pneumonia are more dangerous.

The Preventive measures taken for Encephalitis are:
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis and encephalitis.

Mumps vaccination as part of Measles,mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis and encephalitis

Vaccinations against Japanese Encephalitis is given for travelers going to endemic places with Japanese Encephalitis.