Encephalitis Flashcards
Define Encephalitis?
Inflammation of the brain parenchyma
What is encephalitis most commonly caused by?
Viral Infection
What are the Viral causes of encephalitis?
Herpes Simplex Virus VZV Mumps Adenovirus Coxsackie EBV HIV Japanese Encephalitis
What is the most common Viral cause of encephalitis in the UK?
Herpes Simplex Virus
What are some of the rarer non-viral causes of encephalitis?
Syphilis
Staphylococcus Aureus
What are the causes of encephalitis in immunocompromised patients?
CMV
Toxoplasmosis
Listeria
How is encephalitis somewhat autoimmune or paraneoplastic?
Associated with certain antibodies (e.g. anti-NMDA, anti-VGKC)
What is the epidemiology of encephalitis?
UK incidicence: 7.4/100,000
What are most cases of encephalitis?
Self-limiting and mild
What is the onset of encephalitis?
Subacute (hours to days)
What are the symptoms of encephalitis?
Headache Fever Vomiting Neck Stiffness Photophobia Behavioural Changes Drowsiness Confusion History of seizures Focal neurological symptoms (e.g. dysphagia, hemiplegia)
What is important when dealing with encephalitis?
Obtain a detailed travel history
What are the signs of encephalitis on physical examinagtion?
Reduced consciousness Deteriorating GCS (glasgow coma scale) Seizures Pyrexia Signs of Meningism Signs of raised ICP Focal neurological sins
What are some of the signs of Meningism?
Neck Stiffness
Photophobia
Kernig’s Test postive
What are the signs of raised ICP?
Cushing’s Response: Hypertension + bradycardia + irregular breathing
Papilloedema
How can we use a MMSE?
Mini Mental State Exam (MMSE) can be used reveal cognitive / psychiatric disturbance
What bloods could we do for encephalitis and what might they show?
FBC - high lymphocytes (indicates viral cause)
U & Es - SIADH may occur as a result of encephalitis
Glucose
Viral Serology
ABG
Why might we do a MRI/CT and what might it show?
Exclude mass lesion
HSV causes oedema of the temporal lobe on MRI
How can we use Lumbar Puncture for encephalitis?
High Lymphocytes High Monocytes High protein Glucose is usually normal Viral PCR
What might an EEG show in encephalitis?
Epileptiform activity
What could we use rarely with encephalitis?
Brain Biopsy