Encephalitis

Question 1

What is the most common cause of encephalitis?

Answer 1

HSV

Question 2

What is the most common type of HSV in children? In babies?

Answer 2

Children = HSV 1 from cold sores
Neonates = HSV 2 from genital herpes contracted during birth

Question 3

What are some viral causes of encephalitis? (7)

Answer 3

HSV
VSV = chickenpox
Cytomegalovirus = immunodeficiency
EBV = infectious mononucleosis
Enterovirus
Adenovirus
Influenza virus

Question 4

What are some symptoms of encephalitis? (6)

Answer 4

• Altered consciousness
• Altered cognition
• Unusual behaviour
• Acute onset of focal neurological symptoms
• Acute onset of focal seizures
• Fever

Question 5

What investigations are done in encephalitis? (6)

Answer 5

• Lumbar puncture, sending cerebrospinal fluid for viral PCR testing
• CT scan if a lumbar puncture is contraindicated
• MRI scan after the lumbar puncture to visualise the brain in detail
• EEG recording can be helpful in mild or ambiguous symptoms but is not always routinely required
• Swabs of other areas can help establish the causative organism, such as throat and vesicle swabs
• HIV testing is recommended in all patients with encephalitis

Question 6

What are some contraindications of an LP? (4)

Answer 6

GCS below 9
Haemodynamically unstable
Active seizures
Post ictal

Question 7

What drug is used to treat encephalitis caused by HSV or vsv?

Answer 7

Aciclovir

Question 8

Which drug is used to treat encephalitis caused by cytomegalovirus?

Answer 8

Ganciclovir

Question 9

What are some complications of encephalitis?(10)

Answer 9

• Lasting fatigue and prolonged recovery
• Change in personality or mood
• Changes to memory and cognition
• Learning disability
• Headaches
• Chronic pain
• Movement disorders
• Sensory disturbance
• Seizures
• Hormonal imbalance