Condition- Encephalitis

Question 1

What is encephalitis?

Answer 1

Inflammation of the brain parenchyma

Question 2

What is the most common cause of encephalitis? and list some other viral causes of it too

Answer 2

VIRAL INFECTION:

• HERPES SIMPLEX VIRUS
• VZV
• Mumps
• Adenovirus
• Coxsackie
• EBV
• HIV
• Japanese encephalitis

Question 3

What is the most common bacterial cause of encephalitis? List some non-viral causes of encephalitis…

Answer 3

• Neisseria Meningitides- Meningoecephalitis
• Syphilis
• Staph aureus

Question 4

List some of the causes of encephalitis in immunocompromised patients

Answer 4

Toxoplasma

Listeria

Question 5

List some risk factors for developing encephalitis…

Answer 5

• Immunocompromised
• Viral infections
• Body fluid exposure
• Insect bites
• Location + Season (Japan, monsoon => Japanese Encephalitis)

Question 6

List some of the presenting symptoms of Encephalitis…

Answer 6

• Subacute onset
• Infectious Signs: Fever, rash, lymphadenopathy
• Meningism signs: neck stifness, headache, vomiting
• Neuro/ Psych changes
  
  • Seizures
  • Neurological symptoms (dysphagia, hemiplegia etc)
  • Memory impairement
  • Behvioural changes- confusion
• TRAVEL HISTORY REQUIRED

Question 7

List some of the signs of Encephalitis on examination

Answer 7

• Deteriorating GCS
• Seizures
• Signs of Infection: Pyrexia, lymphadenoapthy
• Signs of Meningism:
  
  • Neck stiffness
  • Photophobia
  • Kernig’s positive
• Signs of raised ICP
  
  • Cushing’s response: hypertension, bradycardia, irregular breathing
  • Papilloedema
• Focal neurological signs
• MMSE=> cognitive distrubance

Question 8

What is the Cushing’s response to RICP?

Answer 8

Hypertension

Low HR

irregular breathing

Question 9

Which investigations would you order for someone with encephalitis?

Answer 9

1. Bedside: HR, RR, BP, sats
2. Bloods:
   
   • Routine: FBC (High lymphocytes= viral cause), U&Es (SIADH may occur), Glucose
   • Specific: Viral serology, ABG, toxoplasma IgM titre, Malaria film
3. MRI/CT
   
   • Exclude mass/lesion
   • HSV causes temporal lobe oedema
   • Meningeal enhancement= meningoencephalitis
4. Lumbar Puncture
   
   • High Lymphocytes
   • High Monocytes
   • High Protein
   • Glucose= normal/ high
   • Viral PCR- HSV
5. EEG
6. Brain biopsy (RARE)

Question 10

Which drug is given to treat herpes encephalitis?

Answer 10

Aciclovir