Encephalitis Flashcards
What is encephalitis?
Inflammation of the brain - infective or non-infective causes
What are the non-infective causes of encephalitis?
Autoimmune –> antibodies are created that target brain tissue.
What is the most common cause of encephalitis in children & adults?
HSV-1 (95% of cases)
What is the most common cause of encephalitis in neonates?
HSV-2 (from genital herpes contracted during birth)
Give some other causes of encephalitis
- HSV1 & 2
- VZV
- Cytalomegalovirus
- EBV etc
Presentation of encephalitis?
- fever
- headache
- altered cognition
- psychiatric symptoms (unusual behaviour)
- seizures
- vomiting
- focal features e.g. aphasia
Investigations in encephalitis?
1) LP - send CSF for viral PCR
2) CT scan (if LP contraindicated)
3) MRI scan
4) EEG
5) HIV testing
What are some contraindications for an LP? (4)
1) GCS <9
2) Haemodynamically unstable
3) Active seizures
4) Post-ictal
CSF features in encephalitis?
Remember - caused by virus.
- lymphocytosis
- normal or raised protein
- normal glucose
Mx of encephalitis?
IV aciclovir
Note - usually started empirically in suspected encephalitis
What are some complications of encephalitis?
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
What part of the brain does HSV encephalitis characteristically affect?
Temporal lobes
Patients may demonstrate temporal lobe signs e.g. aphasia
What is anti-NMDA receptor encephalitis?
A paraneoplastic syndrome.
What is detected in up to 1/2 of female adult patients with anti-NMDA receptor encephalitis?
Ovarian teratomas
Mx of anti-NMDA encephalitis?
immunosuppression with IV steroids etc
