Encephalitis Flashcards
What is the usual clinical presentation of patients with encephalitis?
Fever with evidence of meningeal irritation + the following:
Altered LOC or depressed LOC
- sometimes with hallucinations, behavioral changes or frank psychotic state
What are the most commonly encountered focal findings in encephalitis?
Aphasia Ataxia Upper/lower MN weakness Involuntary movements CN deficits
The most common virus causing encephalitis in immunocompitent individuals?
Herpes viruses
Common viruses causing encephalitis?
Herpes virus
- CMV, HSV 1&2, EBV, Varicella, Human herpes 6
Arthropod
Enteroviruses
True or false all patients with Encephalitis should have CSF examination unless contraindicated?
True
What is the ideal amount of CSF to be taken for examination of Encephalitis?
20 mL
What is the characteristic CSF profile of viral enceph?
Similar to viral meningitis
- opening pressure - notaml to slightly elevated
Protein - normal to slightly elevated
Cells - 25-500 lymphocyte predominant
Glucose - normal
Atypical lymphocytes seen on CSF analysis most probably points to what cuasative agent?
CMV
Primary diagnostic test of choice for CMV, EBV, HHV - 6, enterovirus, HSV
PCR of the CSF
Serology testing has no role in viral strains that are found to have high titers in humans like vzv, hsv, ebv, cmv
True
A focal finding in a patient with encephalitis should always raise the possibility that the causative agent is?
HSV
Nearly 80%. Of HSV encephalitis has this focal finding on imaging?
Temporal lobe abnormalities
EEG abnormalities occur in how many percent of HSV encephalitis?
> 75%
CSF HSV PCR may be negative if done in the first how many hours of encephalitis?
72 hrs
When is brain biopsy done in patients with encephalitis?
Those patients where PCR has failed to lead to a diagnosis
