Encephalitis resident survival guide: Difference between revisions

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'''''Synonyms and Keywords:''''' ''encephalitis management, encephalitis workup, encephalitis approach,encephalitis management, encephalitis treatment, encephalitis diagnosis''  
'''''Synonyms and Keywords:''''' ''encephalitis management, encephalitis workup, encephalitis approach,encephalitis management, encephalitis treatment, encephalitis diagnosis''  


== Overview ==
==Overview==
Encephalitis refers to the inflammation of the brain. The causes of encephalitis are mostly infectious, beign viruses, bacteria, fungi, or parasites the possible agents. Presentation usually involves headache, fever, confusion, neck stiffness (Kernig and Brudzinski signs), and vomiting. Diagnosis is typically based on clinical presentation and supported by blood tests, medical imaging, and analysis of cerebrospinal fluid. A rapid identification of encephalitis is crucial to reduce sequelae. Management is directed against the affecting agent (antivirals, antibiotics), reducing swelling, and supportive measures.
Encephalitis refers to the inflammation of the brain. The causes of encephalitis are mostly infectious, beign viruses, bacteria, fungi, or parasites the possible agents. Presentation usually involves headache, fever, confusion, neck stiffness (Kernig and Brudzinski signs), and vomiting. Diagnosis is typically based on clinical presentation and supported by blood tests, medical imaging, and analysis of cerebrospinal fluid. A rapid identification of encephalitis is crucial to reduce sequelae. Management is directed against the affecting agent (antivirals, antibiotics), reducing swelling, and supportive measures.


== Causes ==
==Causes==


=== Life Threatening Causes ===
===Life Threatening Causes===
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.


=== Common Causes ===
* All causes of encephalitis may be potentially fatal or disabiling if left untreated in 24 hours.; among them:
** Infectious
*** Bacterial
**** Tuberculosis
**** Treponema pallidum
**** Mycoplasma
*** Viral
**** Herpes simplex
**** Epstein-Barr virus
**** Zoster
**** Rabies
**** HIV
**** Cytomegalovirus
**** West Nile virus
**** St. Louis encephalitis virus
**** Japanese encephalitis virus
*** Fungal
**** Coccidioidomycosis
**** Blastomycosis
**** Histoplasmosis
**** Cryptococcosis
*** Protozoan
**** Granulomatous amebic
**** Toxoplasma
**** Bartonella Henselae
** Autoimmune
** Encephalitis lethargica
** Limbic encephalitis


== Diagnosis ==
===Common Causes===
 
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of encephalitis according to the American Academy of Neurology guidelines:
Shown below is an algorithm summarizing the diagnosis of encephalitis according to the American Academy of Neurology guidelines:
<br />
{| class="wikitable"
|
=== Diagnostic Criteria for Encephalitis and Encephalopathy of Presumed Infectious or Autoimmune Etiology according to the International Encephalitis Consortium ===
|-
| colspan="1" rowspan="1" |'''Major Criterion (required):'''
|-
| colspan="1" rowspan="1" |Patients presenting to medical attention with altered mental status (defined as decreased or altered level of consciousness, lethargy orpersonality change) lasting ≥24 h with no alternative cause identified.
|-
| colspan="1" rowspan="1" |'''Minor Criteria (2 required for possible encephalitis; ≥3 required for probable or confirmeda encephalitis):'''
|-
| colspan="1" rowspan="1" |Documented fever ≥38° C (100.4°F) within the 72 h before or after presentationb
|-
| colspan="1" rowspan="1" |Generalized or partial seizures not fully attributable to a preexisting seizure disorderc
|-
| colspan="1" rowspan="1" |New onset of focal neurologic findings
|-
| colspan="1" rowspan="1" |CSF WBC count ≥5/cubic mmd
|-
| colspan="1" rowspan="1" |Abnormality of brain parenchyma on neuroimaging suggestive of encephalitis that is either new from prior studies or appears acute in onsete
|-
| colspan="1" rowspan="1" |Abnormality on electroencephalography that is consistent with encephalitis and not attributable to another cause.f
|-
|Do not modify
|}


== Treatment ==
==Treatment==
Shown below is an algorithm summarizing treatment of encephalitis according to the American Academy of Neurology guidelines:
Shown below is an algorithm summarizing treatment of encephalitis according to the American Academy of Neurology guidelines:


== Do's ==
==Do's==


== Don'ts ==
==Don'ts==


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 09:01, 7 January 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.

Synonyms and Keywords: encephalitis management, encephalitis workup, encephalitis approach,encephalitis management, encephalitis treatment, encephalitis diagnosis

Overview

Encephalitis refers to the inflammation of the brain. The causes of encephalitis are mostly infectious, beign viruses, bacteria, fungi, or parasites the possible agents. Presentation usually involves headache, fever, confusion, neck stiffness (Kernig and Brudzinski signs), and vomiting. Diagnosis is typically based on clinical presentation and supported by blood tests, medical imaging, and analysis of cerebrospinal fluid. A rapid identification of encephalitis is crucial to reduce sequelae. Management is directed against the affecting agent (antivirals, antibiotics), reducing swelling, and supportive measures.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

  • All causes of encephalitis may be potentially fatal or disabiling if left untreated in 24 hours.; among them:
    • Infectious
      • Bacterial
        • Tuberculosis
        • Treponema pallidum
        • Mycoplasma
      • Viral
        • Herpes simplex
        • Epstein-Barr virus
        • Zoster
        • Rabies
        • HIV
        • Cytomegalovirus
        • West Nile virus
        • St. Louis encephalitis virus
        • Japanese encephalitis virus
      • Fungal
        • Coccidioidomycosis
        • Blastomycosis
        • Histoplasmosis
        • Cryptococcosis
      • Protozoan
        • Granulomatous amebic
        • Toxoplasma
        • Bartonella Henselae
    • Autoimmune
    • Encephalitis lethargica
    • Limbic encephalitis

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of encephalitis according to the American Academy of Neurology guidelines:

Diagnostic Criteria for Encephalitis and Encephalopathy of Presumed Infectious or Autoimmune Etiology according to the International Encephalitis Consortium

Major Criterion (required):
Patients presenting to medical attention with altered mental status (defined as decreased or altered level of consciousness, lethargy orpersonality change) lasting ≥24 h with no alternative cause identified.
Minor Criteria (2 required for possible encephalitis; ≥3 required for probable or confirmeda encephalitis):
Documented fever ≥38° C (100.4°F) within the 72 h before or after presentationb
Generalized or partial seizures not fully attributable to a preexisting seizure disorderc
New onset of focal neurologic findings
CSF WBC count ≥5/cubic mmd
Abnormality of brain parenchyma on neuroimaging suggestive of encephalitis that is either new from prior studies or appears acute in onsete
Abnormality on electroencephalography that is consistent with encephalitis and not attributable to another cause.f
Do not modify

Treatment

Shown below is an algorithm summarizing treatment of encephalitis according to the American Academy of Neurology guidelines:

Do's

Don'ts

References

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