Encephalitis

Question 1

Presentation of encephalitis

Answer 1

Altered consciousness, altered cognition, unusual behaviour, acute onset of focal neurological symptoms, acute onset of focal seizures, fever

Question 2

Causes of encephalitis

Answer 2

Most commonly viral - HSV-2 in neonates and HSV - 1 in infants.
Other viral causes such as varicella zoster virus, CMV, EBV, enterovirus, adenovirus and influenza

Question 3

Diagnosis of encephalitis

Answer 3

LP for viral PCR testing, MRI after LP, swabs of other areas to help establish causative agent, HIV testing recommended in all patients

Question 4

Management of encephalitis

Answer 4

Aciclovir testing HSV and VZV, ganciclovir treating CMV, repeat LP

Question 5

Complications of encephalitis

Answer 5

Lasting fatigue and prolonged recovery, change in personality and mood, memory and cognition, learning disability, headache, chronic pain, movement disorders, sensory disturbance, seizures and hormonal imbalance

Question 6

Causes of encephalopathy

Answer 6

Hypoglycaemia, hepatic encephalopathy, DKA, drug induced, uraemic, SLE, hypoxic, Beri-Beri

Question 7

Where does HSV1 have a tendency to go in the brain

Answer 7

Predilection for temportal lobes and bilateral multifocal haemorrhage is typical

Question 8

Treatment of encephalitis

Answer 8

Broad antimicrobial cover with 2g IV ceftriaxone BD and 10mg/kg of aciclovir TDS foe 2 weeks

Question 9

Side effects of aciclovir

Answer 9

Faigue, malaise, GI disturbance, photosensitivity, urticarial rash, AKI, haematological abnormalities, hepatitis, neurological reactions