Encephalitis

Question 1

What is the most common cause of infective encephalitis?

Answer 1

HSV (1 is more common than 2)

Question 1

What are some major symptoms of encephalitis?

Answer 1

Fever, headache, stiff neck, altered mental status

Question 2

Encephalitis in the brainstem may lead to what symptoms?

Answer 2

Autonomic dysfunction, myoclonus and cranial neuropathies

Question 3

Encephalitis in the flavivirus may lead to what symptoms?

Answer 3

Tremor or movement disorders

Question 4

How does the HSV virus lead to infective encephalitis?

Answer 4

The virus migrates through to the trigeminal ganglia or the olfactory bulb, the virus then replicates again and stays latent and then reactivated

Question 5

When should treatment for suspected infective encephalitis be started?

Answer 5

As soon as there is a suspicion

Question 6

How would infective encephalitis show in a lumbar puncture?

Answer 6

Raised white blood cell count

Question 7

How would infective encephalitis show in imaging?

Answer 7

High signal change and T2 hyper intense lesions in the frontal temporal regions

Question 8

What is the role of the drug Acyclovir?

Answer 8

An antiviral medication to prevent the spread of the herpes virus

Question 9

What is paraneoplastic encephalitis?

Answer 9

Relates to a systemic cancer

Question 10

How does systemic cancer lead to intracellular encephalitis?

Answer 10

Antibodies are made due to the cancer which target nerve cells in the CNS, leads to the activation of T cells with neuronal loss

Question 11

How does systemic cancer lead to extracellular encephalitis?

Answer 11

Antibodies interfere with normal functioning, neurones can’t transmit signals to each other and leads to a neurological syndrome

Question 12

What are the symptoms associated with limbic encephalitis?

Answer 12

Irritability, depression, sleep disturbances, seizures, hallucinations and short term memory loss

Question 13

What are the four criteria for diagnosing limbic encephalitis?

Answer 13

1. sub-acute onset
2. bilateral brain abnormalities
3. high white blood cell count or epileptic activity on EEG
4. reasonable exclusion of other causes

Question 14

What is the main proteins causing limbic encephalitis?

Answer 14

LGI-1 and NMDA

Question 15

What is the role of LGI-1?

Answer 15

Bridges ADAM22 and ADAM23 molecules

Question 16

How does LGI-1 cause limbic encephalitis?

Answer 16

Antibodies attach to the receptor and stop the connection and communication of the molecules

Question 17

What symptom is associated with LGI-1 distruption?

Answer 17

Faciobrachial dystonic seizures

Question 18

What would CSF, EEG and MR show for disruption of LGI-1?

Answer 18

Normal CSF, abnormal EEG and abnormal MR

Question 19

How does NMDA cause limbic encephalitis?

Answer 19

Antibodies attach to the NMDA receptor, receptors then crosslink and are removed from the postsynaptic membrane due to mitosis and stops normal signalling between the pre and post synaptic neuron

Question 20

What symptoms are associated with NMDA disconnection?

Answer 20

Flu symptoms, psychiatric symptoms, movement disorders and seizures

Question 21

What would CSF, EEG and MR show when NMDA receptors are disconnected?

Answer 21

CSF normal, EEG generalised or focal seizure activity, MR normal

Question 22

What is the first line pharmacological drug for autoimmune encephalitis?

Answer 22

Corticoidsteroids

Question 23

What is the role of corticoid steroids?

Answer 23

Bind to glucocorticoid receptors and promote anti-inflammatory genes and decrease inflammatory response genes

Question 24

What are the other three non-pharmacological first line treatments for autoimmune encephalitis?

Answer 24

Intravenus immunoglobin
Plasma exchange
Tumour treatment/removal