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Z Year3 Neuro Conditions > Encephalitis > Flashcards

Encephalitis Flashcards

1
Q

What is encephalitis?

A

pathological state of brain parenchymal dysfunction leading to an altered state of consciousness or focal neurological signs

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2
Q

What part of brain is affected in encephalitis?

A

inflammatory process in brain parenchyma

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3
Q

What are causes for encepahlitis?

A
  • Infectious and non-infectious causes

- Aetiological agent only identified in around 50% of cases

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4
Q

What are main viral causes for encephalitis?

A
  1. HSV-1 and 2
  2. Arbovirsuses
  3. CMV
  4. EBV
  5. VZV
  6. HIV
  7. MMR
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5
Q

What are common non viral causes of encephalitis?

A
  1. Any bacterial meningitis
  2. TB
  3. Malaria
  4. Lyme disease etc
  5. Parasitic
  6. Prion disease
  7. Autoimmune syndrome
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6
Q

What are common symptoms and signs of encephalitis?

A
  1. Fever
  2. Headache
  3. Low GCS or coma
  4. Altered mental status
  5. Siezures
  6. Focal neurological deficit
  7. Meningismus
  8. Cough
  9. Gi infection
  10. Seizures
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7
Q

What are possible DDx for encephalitis?

A
  1. Aseptic meningitis
  2. Encephalopathy
  3. Status epilepticus
  4. CNS vasculitis Malignant hypertension
    Etc.
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8
Q

What bloods would you order for encephalitis?

A
  1. FBC
  2. Peripheral blood smear
  3. Serum eelctrolytes
  4. LFTs
  5. Blood culture
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9
Q

What would FBC show in encephalitis?

A

elevated WBC

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10
Q

What may peripheral blood smear show in encephalitis?

A

can have detection of Plasmodium falciparum and Ehrlichia

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11
Q

What may serum electrolytes show in encephalitis?

A

hypoatraemia

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12
Q

What would LFTs show in encephalitis?

A

elevated

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13
Q

What would blood cultures be like in encephalitis?

A

detection and confirmation of systemic bacterial infections and most arboviral infections

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14
Q

What special tests do you do in encephalitis?

A
  1. Throat swab
  2. Nasopharyngeal aspirate
  3. Sputum culture
  4. CSF analysis
  5. CSF serology
  6. CSF PCR
  7. CSF culture
  8. LP
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15
Q

What would throat swab in encephalitis show?

A

detection of viruses

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16
Q

What would nasopharyngeal aspirate show in encepahlitis?

A

can show respiratory viruses

17
Q

What would sputum culture show in encephalitis?

A

detection of Mycoplasma, tuberculosis (acid-fast stain), and fungal infections

18
Q

What would CSF analysis show in encephalitis?

A
  • depends on cause but can be elevated WBC, RBC, protein or low glucose
  • High CSF protein and lymphocytes and low glucose usually
19
Q

What imaging do you do for encephalitis?

A
  1. Contrast enhanced CT brain
  2. MRI brain
  3. EEG
  4. CXR
20
Q

What would contrast enhanced CT brain show in encephalitis?

A
  1. normal in early stages
  2. but focal bilateral temporal lobe involvement suggests HSV encephalitis
  3. meningeal enhancement suggest menigealencepahlitis
21
Q

What would MRI brain show in encephalitis?

A

can have hyperintense lesion and increased diffusion of DWI

22
Q

What would EEG show in encephalitis?

A

can show background slowing

23
Q

What would CXR show in encephalitis?

A

: may detect a non-infectious or infectious cause (e.g. tuberculosis, sarcoidosis)

24
Q

What is first line treatment for encephalitis?

A

Aciclovir: 10mg/kg IV every 8 hours for 10-21 days – start with 30mins
-Or combination antiviral therapy if immunosuppressed

25
Q

What additional treatment is used for encephalitis?

A
  • Plus sometimes Corticosteroid
  • Supportive therapy in ICU or HDU is appropriate
  • Symptomatic treatment e.g. phenytoin for seizures
26
Q

What are possible complications of encephalitis?

A
  1. Death
  2. Hypothalamic and autonomic dysfunction
  3. Ischaemic stroke
  4. Encephalitis lethargica
  5. Neurological sequelae
  6. Seizures
  7. Cerebral vein haemorrhage
27
Q

What is mortality of encephalitis like?

A
  • Mortality as an outcome occurs in 6% to 9% in the US, and in 12% in England
  • Mortality in untreated viral encephalitis is around 70%
28
Q

When should you always suspect encephalitis?

A
  • odd behaviour:
    1. Decreased consciousness
    2. Focal neurology or seizure preceded by infectious (high temp, rash, lymphadenopathy, coldsores)
29
Q

What is the intial treatment for encephalitis?

A
  1. Give Aciclovir to all patients with suspected encephalitis
  2. Then give the appropriate antiviral or antibiotic according to the underlying aetiolgoy (typically viral)
30
Q

What is the difference between meningitis and encephalitis with location?

A
  • Meningitis: meninges

- Enceaphlitis: brain parenchyma

31
Q

What is the difference between meningitis and encephalitis with aetiology?

A
  • Meningitis: bacterial, viral, TB

- Encephalitis: usually viral

32
Q

What is the difference between meningitis and encephalitis with conciousness?

A
  • Meningitis: usually unimpaired

- Encephalitis: usually altered

Z Year3 Neuro Conditions (34 decks)

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