Viral encephalitis physical examination

Template:Encephalitis Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]

Overview

Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. It may present as focal or diffuse neurological manifestations. The signs may include altered mental status, change in personality, meningismus, ataxia, seizures, and cranial nerve involvement. Stiff neck, due to the irritation of the meninges covering the brain, indicates that the patient has either meningitis or meningeoncephalitis.

Physical examination

Focal

Focal neurological signs are found commonly in patients with Herpes simplex encephalitis. Common findings in encephalitis are:

• Focal seizures
• Cranial nerve palsy
• Dysphagia (Rabies)

Diffuse

• Altered sensorium
• Personality changes
• Autonomic dysfunction
• Hemiparesis
• Meningismus
• Dystonia
• Ataxia
• Abnormal reflexes

Herpes simplex encephalitis

It is commonly seen in neonates and physical examination may include:

General physical examination

• Decreased consciousness, irritability
• Bulging fontanelles
• Jaundice
• Keratoconjunctivitis
• Herpetic skin lesions
• Shock

Gastrointestinal

• Herpetic lesions in tongue and buccal mucosa (mouth ulcers)
• Hepatomegaly

Neurological

• Seizures