Encephalitis

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What is Encephalitis?

Encephalitis refers to an inflammation or infection of the brain that occurs due to a virus infecting the brain tissues or the immune system attacking the brain in error.

Is Encephalitis a Medical emergency?

Yes, It is a medical emergency.

Types

There are two main types:

  • Primary Encephalitis: A virus directly infects the brain and spinal cord, causing Encephalitis. This is called primary Encephalitis.
  • Secondary Encephalitis: An infection that starts elsewhere in the body spreads to the brain, causing Encephalitis. This is called secondary Encephalitis.

Causes

The following are the causes:

  • Virus: Different kinds of viruses can cause Encephalitis. The most common virus that causes this disease is the herpes simplex Other viruses that cause Encephalitis to include rabies, poliovirus, measles, tick-borne viruses, and mosquito-borne viruses.
  • Bacteria: Bacterial infection such as bacterial meningitis, Lyme disease, tuberculosis, and syphilis can cause Encephalitis.
  • Parasite: Certain parasites like toxoplasmosis and malaria parasite can cause Encephalitis.
  • Auto-immune reaction: An autoimmune reaction means the body’s immune system attacks healthy brain tissues. This may be due to the immune system over-reacting to an infection that is present somewhere in the body or might not even be still present in the body.

Risk factors

Factors that influence the development may include the following:

  • Age: It is more common in children under age 1 and older adults
  • Weak immune systems: Individuals with weak immune systems are more vulnerable to viral infections and the risk of developing Encephalitis
  • Place of living and seasons of the year: Individuals who live in regions where mosquito and tick bites are common are at higher risk of developing this disease. Also, it is more common in seasons like summer and fall when these insects are active.

Signs & symptoms

Signs and symptoms of Encephalitis may include:

  • Headache
  • Stiff neck, muscle aches, and joint pains
  • Fever
  • Vomiting
  • Weakness
  • Confusion
  • Seizures
  • Loss of consciousness
  • Hallucinations
  • Difficulty speaking and hearing problems
  • Muscle weakness and loss of sensation in a few parts of the body

Signs and symptoms of Encephalitis in infants are as follows:

  • Bulging in the fontanels (soft spots on the infant’s skull)
  • Body stiffness
  • Nausea and vomiting
  • Sensitivity to light
  • Decreased feeding and not waking up in between for feeding
  • Increased irritability
  • Change in alertness and being more drowsy
  • Low energy
  • Skin rash
  • Difficulty talking

Investigations

Investigation tests that are performed to diagnose are:

  • Laboratory tests: Blood, urine, and throat secretions are tested to rule out any viral or bacterial infections
  • Lumbar puncture (spinal tap): Fluid from the spinal cord is collected to check for any virus or infections. Changes in spinal fluid suggest infections in the brain
  • Imaging tests: Imaging tests like brain CT and MRI are performed to rule out swelling of the brain, tumors, or other abnormalities
  • Electroencephalogram (EEG): This test is performed to check the brain’s electrical activity
  • Brain biopsy: A small tissue of the brain is collected to check for any abnormalities
  • Polymerase chain reaction (PCR) test: Fluid from the spine is tested for the presence of viral DNA, which is the sign of Encephalitis

Diagnosis

The diagnosis of Encephalitis is made on reviewing the symptoms and considering the results of the investigation tests.

Treatment options

It requires treatment in a hospital setting. Medical treatment along with adequate bed rest, plenty of liquids, and supportive care measures help in the treatment of Encephalitis.

Medical treatment

Medical treatment includes the following:

  • Anti-inflammatory drugs: Anti-inflammatory drugs like acetaminophen, ibuprofen, and naproxen sodium are administrated for fever and headaches
  • Anti-viral drugs: It is caused due to a viral infection, anti-viral medications such as acyclovir, ganciclovir, and foscarnet
  • Anticonvulsant medications: These medications are prescribed to stop or prevent seizures

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Supportive care and other therapies are also provided for individuals who are hospitalized for this disease. They include the following:

  • Intravenous fluids are provided for hydration
  • Artificial respiration is provided: Breathing and heart function are carefully monitored
  • Anti-inflammatory medications are provided to reduce swelling and pressure in the skull
  • Anticonvulsant medications are provided to prevent seizures
  • Physical and occupational therapies are provided to improve strength, balance, movement, coordination, and better functioning of daily life activities
  • Speech therapy is provided to improve the speech
  • Psychotherapy is provided to improve behavior, personality changes, and mood disorders

Preventive measures may include:

  • Getting vaccinations up-to-date
  • Avoid sharing utensils, food, and beverages
  • Maintaining good hygiene habits
  • Taking protecting measures against mosquitoes and ticks
  • Avoid consuming outside water

Complications

It can lead to the following neurological disorders and complications:

  • Seizures
  • Hallucinations
  • Memory problems
  • Difficulty speaking
  • Hearing and vision problems
  • Lack of muscle coordination
  • Paralysis
  • Weakness and fatigue

Prognosis

The prognosis of Encephalitis that is associated with cerebral edema, status epilepticus, and thrombocytopenia is critical. However, the prognosis of early detected Encephalitis with appropriate treatment is good.

When to contact the doctor? / How to identify the complications?

Immediate medical attention is warranted once noticing symptoms.

Indications for hospitalization if required

It requires immediate hospitalization and close observation. Measures are taken to reduce the swelling in the head, prevent seizures, control infection, fever, and prevent other related complications.

Suggested clinical specialists/ Departments to consult for this condition

  • Neurology
  • Infectious disease
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