Encephalitis: Difference between revisions
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===[[HZV]] encephalitis===
===[[HZV]] encephalitis===
#[[Acyclovir]] 10mg/kg every 8hr
#[[Acyclovir]] 10mg/kg every 8hr
===[[CMV]] encephalitis
===[[CMV]] encephalitis===
#Ganciclovir 5mg/kg IV every 12hr OR
#Ganciclovir 5mg/kg IV every 12hr OR
#Foscarnet 90mg/kg IV every 12 hrs
#Foscarnet 90mg/kg IV every 12 hrs

Revision as of 20:12, 6 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

  1. New psychiatric symptoms (HSV)[1]
  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

HSV encephalitis

  1. Acyclovir 10mg/kg every 8hrs

HZV encephalitis

  1. Acyclovir 10mg/kg every 8hr

CMV encephalitis

  1. Ganciclovir 5mg/kg IV every 12hr OR
  2. Foscarnet 90mg/kg IV every 12 hrs

Disposition

  1. Admit

Source

  • Tintinalli
  • 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.
  1. ↑ 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.
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