Encephalitis

Question 1

Clinical picture of Encephalitis

Answer 1

Clinical picture: fever, neuro symptoms (nausea, vomiting, headache, AMS)
■ Focal neurological deficits / focal seizure more typical of HSV
encephalitis
■ Does NOT have neck pain/stiffness: can help distinguish from
meningitis

Question 2

Causes of Encephalitis

Answer 2

Causes:
■ Viral: HSV, enteroviruses, arboviruses (Tick-borne, West Nile),
CMV, rabies
■ Bacteria: Lyme, Rickettsia, Mycoplasma pneumoniae, Bartonella

Question 3

Diagnosis of Encephalitis

Answer 3

CT + lumbar puncture with PCR (especially for HSV). DO NOT PERFORM LUMBAR PUNCTURE IF High ICP

Question 4

Treatment of Encephalitis

Answer 4

■ Usually viral, give acyclovir empirically in case it is HSV.
■ Bacterial: 3rd gen cephalosporins
■ Doxycycline if borrelia or rickettsia
■ May need seizure control with benzodiazepines
■ May need to reduce ICP with diuretics, e.g. furosemide