Encephalitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*New psychiatric symptoms (HSV)<ref>Loring KE, Tintinalli JE: Central Nervous System and Spinal Infections, in Tintinalli JE, Kelen GD, Stapczynski JS (eds): Emergency Medicine, A Comprehensive Study Guide, ed 7. New York, McGraw-Hill, 2011, (Ch) 168:p 1175-1176.</ref> | |||
*Cognitive deficits | |||
**Aphasia, amnesia, confusion | |||
*[[Seizure]] | |||
*Movement disorder (arboviruses) | |||
*[[Fever]] and meningeal signs are almost always present | |||
==Differential Diagnosis== | |||
*[[Meningitis]] | |||
*[[SAH]] | |||
*[[Lyme disease]] | |||
*Brain abscess | |||
*Bacterial [[endocarditis]] | |||
*Toxic / metabolic encephalopathy | |||
==Diagnosis== | ==Diagnosis== | ||
*CT Head | |||
**Medial temporal and inf frontal grey matter c/w HSV | |||
*[[LP]] | |||
**Bloody tap c/w HSV | |||
==Treatment== | ==Treatment== | ||
Revision as of 00:52, 7 April 2015
Background
- Infection of brain parenchyma of the temporal lobes and inferior frontal lobe causing distinct neurologic abnormality
- Pathophysiology
- Gray matter is predominantly affected (cognitive / psychiatric signs, lethargy, seizure)
Microbiology
Clinical Features
- New psychiatric symptoms (HSV)[1]
- Cognitive deficits
- Aphasia, amnesia, confusion
- Seizure
- Movement disorder (arboviruses)
- Fever and meningeal signs are almost always present
Differential Diagnosis
- Meningitis
- SAH
- Lyme disease
- Brain abscess
- Bacterial endocarditis
- Toxic / metabolic encephalopathy
Diagnosis
- CT Head
- Medial temporal and inf frontal grey matter c/w HSV
- LP
- Bloody tap c/w HSV
Treatment
Often it is unclear which type of encephalitis is present and starting Acyclovir empirically is appropriate. In addition to the pathogens below, possible causes can include West Nile Virus, EBV, HIV, toxoplasmosis, or rabies.
HSV encephalitis
- Acyclovir 10mg/kg (10-15mg/kg for pediatrics) every 8hrs
HZV encephalitis
- Acyclovir 10mg/kg every 8hr
CMV encephalitis
- Ganciclovir 5mg/kg IV every 12hr OR
- Foscarnet 90mg/kg IV every 12 hrs
Tick Associated (Borrelia burgdorferi, Ehrlichiosis or Rickettsia)
- Doxycycline 200 mg IV once followed by 100 mg IV twice daily
Disposition
Admit in all cases
Source
- ↑ Loring KE, Tintinalli JE: Central Nervous System and Spinal Infections, in Tintinalli JE, Kelen GD, Stapczynski JS (eds): Emergency Medicine, A Comprehensive Study Guide, ed 7. New York, McGraw-Hill, 2011, (Ch) 168:p 1175-1176.