Encephalitis: Difference between revisions

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==Background==
==Background==
*Infection of brain parenchyma causing distinct neurologic abnormality
*Infection of brain parenchyma causing distinct neurologic abnormality
*Microbiology
**HSV, HZV, EBV, CMV, rabies, arboviruses (West Nile, St. Louis equine)
*Pathophysiology
*Pathophysiology
**Gray matter is predominantly affected (cognitive / psychiatric signs, lethargy, seizure)
**Gray matter is predominantly affected (cognitive / psychiatric signs, lethargy, seizure)
===Microbiology===
*[[HSV]]
*[[HZV]]
*[[EBV]]
*[[CMV]]
*[[Rabies]]
*Arboviruses ([[West Nile]], St. Louis equine)


==Clinical Features==
==Clinical Features==
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#Cognitive deficits
#Cognitive deficits
##Aphasia, amnesia, confusion
##Aphasia, amnesia, confusion
#Seizure
#[[Seizure]]
#Movement disorder (arboviruses)
#Movement disorder (arboviruses)
#Fever and meningeal signs are almost always present
#[[Fever]] and meningeal signs are almost always present


==Diagnosis==
==Diagnosis==
#CT Head
#CT Head
##Medial temporal and inf frontal grey matter c/w HSV
##Medial temporal and inf frontal grey matter c/w HSV
#LP
#[[LP]]
##Bloody tap c/w HSV
##Bloody tap c/w HSV


==DDX==
==DDX==
#Meningitis
#[[Meningitis]]
#SAH
#[[SAH]]
#Lyme disease
#[[Lyme disease]]
#Brain abscess
#Brain abscess
#Bacterial endocarditis
#Bacterial [[endocarditis]]
#Toxic / metabolic encephalopathy
#Toxic / metabolic encephalopathy


==Treatment==
==Treatment==
#HSV encephalitis
#HSV encephalitis
##Acyclovir 10mg/kg q8hr
##[[Acyclovir]] 10mg/kg q8hr
#HZV encephalitis
#HZV encephalitis
##Acyclovir 10mg/kg q8hr
##[[Acyclovir]] 10mg/kg q8hr
#CMV encephalitis
#CMV encephalitis
##Ganciclovir 5mg/kg IV q12hr
##Ganciclovir 5mg/kg IV q12hr

Revision as of 18:04, 21 September 2014

Background

  • Infection of brain parenchyma causing distinct neurologic abnormality
  • Pathophysiology
    • Gray matter is predominantly affected (cognitive / psychiatric signs, lethargy, seizure)

Microbiology

Clinical Features

  1. New psychiatric symptoms (HSV)
  2. Cognitive deficits
    1. Aphasia, amnesia, confusion
  3. Seizure
  4. Movement disorder (arboviruses)
  5. Fever and meningeal signs are almost always present

Diagnosis

  1. CT Head
    1. Medial temporal and inf frontal grey matter c/w HSV
  2. LP
    1. Bloody tap c/w HSV

DDX

  1. Meningitis
  2. SAH
  3. Lyme disease
  4. Brain abscess
  5. Bacterial endocarditis
  6. Toxic / metabolic encephalopathy

Treatment

  1. HSV encephalitis
    1. Acyclovir 10mg/kg q8hr
  2. HZV encephalitis
    1. Acyclovir 10mg/kg q8hr
  3. CMV encephalitis
    1. Ganciclovir 5mg/kg IV q12hr

Disposition

  1. Admit

Source

Tintinalli