Encephalitis

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Encephalitis

• inflammation of brain parenchyma
• usually viral infection
• may be bacterial or fungal

Organisms

• Herpes Simplex Virus (type I)
  • mortality 20%
• Echo
• Coxsachie
• Mumps
• Epstein-Barr Virus
• Rabies
• Japanese Encephalitis (SE Asia)
• Ross River Fever (Australia)
• California Encephalitis (USA)
• Omsk Haemorrhagic fever (Russia)
• Tick borne flavivirus encephalitis (Sweden / Central Europe)

Clinical Features

• over hours to days
  • fever
  • headache
  • mood change
  • drowsiness
• focal signs
• seizures
• coma

Differential

• bacterial Meningitis
• Brain Abscess
• acute disseminated encephalomyelitis
• cerebral Malaria
• toxic confusional states (febrile illness / septicaemia)

Investigations

• CT / MRI
  • diffuse areas of oedema - often temporal lobes
• EEG
  • characteristic slow wave changes
• CSF
  • clear / turbid
  • 10-100 mononuclear cell / ml
  • nil polymorphs
  • protein 0.4-0.8 g / l
  • > ½ blood glucose
• viral serology

Treatment

• IV Acyclovir

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