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Medical Author: Charles Patrick Davis, MD, PhD Medical Editor: Melissa Conrad Stppler, MD, Chief Medical Editor

http://www.emedicinehealth.com/encephalitis/page3_em.htm#encephalitis_symptoms_and_signs

Encephalitis Symptoms and Signs

The signs and symptoms of encephalitis are the same for adults and children. Infants may have poor feeding, irritability, vomiting, bulging fontanel, and body stiffness; such symptoms in an infant always constitute a medical emergency.

Signs and symptoms may last for two to three weeks, are flu-like, and can include one or more of the following: o Fever o Fatigue o Sore throat o Stiff neck and back o Vomiting o Headache o Confusion o Irritability o Unsteady gait o Drowsiness o Visual sensitivity to light More severe cases may involve these signs and symptoms: o Seizures o Muscle weakness o Paralysis o Memory loss o Sudden impaired judgment o Poor responsiveness

http://www.emedicinehealth.com/encephalitis/page5_em.htm#encephalitis_diagnosis

Encephalitis Diagnosis
The doctor will often question a patient about their travel history. Geographic location and seasonal occurrence can help identify the specific cause of encephalitis. The doctor will often do a physical exam that includes looking for insect bites and will probably complete a neurologic evaluation. The physician often will order some blood tests including a CBC. Depending on the patient's unique situation, the doctor may perform one or more of the following tests:

An imaging study of the brain such as a CT scan or magnetic resonance imagining (MRI) is often done. MRI is the procedure of choice if herpes encephalitis is suspected. A DNA study called polymerase chain reaction (PCR) has greatly improved the diagnosis of herpes encephalitis. Variations of this test are used by the CDC and some state agencies to identify the various other virus types that may cause encephalitis. A reading of the electrical activity of the brain with an EEG can detect irregularities. Herpes encephalitis produces a characteristic EEG pattern. A lumbar puncture, also known as a spinal tap, may be necessary to isolate and identify the virus. During this procedure, the doctor applies local numbing medication and then inserts a needle into the lower back to collect fluid from the space around the spinal column for analysis. The virus may also be isolated from tissue or blood. Brain biopsy is an option although it is rarely done and usually only if the other tests do not give an answer.

A.D.A.M. Medical Encyclopedia.

Encephalitis
Last reviewed: August 1, 2012. Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections. See also: Meningitis

Causes, incidence, and risk factors

Encephalitis is a rare condition. It occurs more often in the first year of life and decreases with age. The very young and the elderly are more likely to have a severe case. Encephalitis is most often caused by a viral infection. Many types of viruses may cause it. Exposure to viruses can occur through:

Breathing in respiratory droplets from an infected person Contaminated food or drink Mosquito, tick, and other insect bites Skin contact

Different viruses will occur in different locations. Many cases will tend to cluster in a certain season. Encephalitis caused by the herpes simplex virus is the leading cause of more severe cases in all ages, including newborns. A number of viruses for which there is now a vaccine may also cause encephalitis. These include:

Measles Mumps Polio Rabies Rubella Varicella (chickenpox)

Other viruses that cause encephalitis include:

Adenovirus Coxsackievirus Cytomegalovirus Eastern Equine Encephalitis Virus Echovirus West Nile virus

The virus causes inflammation of brain tissue. The brain tissue swells (cerebral edema), which may destroy nerve cells, cause bleeding in the brain (intracerebral hemorrhage), and brain damage. Other causes of encephalitis may include:

An allergic reaction to vaccinations Autoimmune disease Bacteria, such as Lyme disease,syphilis, and tuberculosis Parasites such as roundworms, cysticercosis, and toxoplasmosis in AIDS patients and other people who have a weakened immune system The effects of cancer

Symptoms
Some patients may have symptoms of a cold or stomach infection before encephalitis symptoms begin. When a case of encephalitis is not very severe, the symptoms may be similar to those of other illnesses, including:

Fever that is not very high Mild headache Low energy and a poor appetite

Other symptoms include:

Clumsiness, unsteady gait Confusion, disorientation Drowsiness Irritability or poor temper control Light sensitivity Stiff neck and back (occasionally) Vomiting

Symptoms in newborns and younger infants may not be as easy to recognize:

Body stiffness Irritability and crying more often (these symptoms may get worse when the baby is picked up) Poor feeding Soft spot on the top of the head may bulge out more Vomiting

Emergency symptoms:

Loss of consciousness, poor responsiveness, stupor, coma Muscle weakness or paralysis Seizures Severe headache Sudden change in mental functions: o "Flat" mood, lack of mood, or mood that is inappropriate for the situation o Impaired judgment o Inflexibility, extreme self-centeredness, inability to make a decision, or withdrawal from social interaction o Less interest in daily activities o Memory loss (amnesia), impaired short-term or long-term memory

Signs and tests

An examination may show:

Abnormal reflexes Increased intracranial pressure Mental confusion Mouth ulcers Muscle weakness Neck stiffness Signs in other organs, such as the liver and lungs Skin rash Speech problems

Tests may include:

Brain MRI

CT scan of the head Culture of cerebrospinal fluid (CSF), blood, or urine (however, this test is rarely useful) Electroencephalogram (EEG) Lumbar puncture and CSF examination Tests that detect antibodies to a virus (serology tests) Test that detects tiny amounts of virus DNA (polymerase chain reaction -- PCR)

Treatment
The goals of treatment are to provide supportive care (rest, nutrition, fluids) to help the body fight the infection, and to relieve symptoms. Reorientation and emotional support for confused or delirious people may be helpful. Medications may include:

Antiviral medications, such as acyclovir (Zovirax) and foscarnet (Foscavir) -- to treat herpes encephalitis or other severe viral infections (however, no specific antiviral drugs are available to fight encephalitis) Antibiotics -- if the infection is caused by certain bacteria Anti-seizure medications (such as phenytoin) -- to prevent seizures Steroids (such as dexamethasone) -- to reduce brain swelling (in rare cases) Sedatives -- to treat irritability or restlessness Acetaminophen -- for fever and headache

If brain function is severely affected, interventions like physical therapy and speech therapy may be needed after the illness is controlled.

Expectations (prognosis)
The outcome varies. Some cases are mild and short, and the person fully recovers. Other cases are severe, and permanent impairment or death is possible. The acute phase normally lasts for 1 - 2 weeks. Fever and symptoms gradually or suddenly disappear. Some people may take several months to fully recover.

Complications
Permanent brain damage may occur in severe cases of encephalitis. It can affect:

Hearing Memory Muscle control Sensation Speech Vision

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have:

Sudden fever Other symptoms of encephalitis

Prevention
Children and adults should avoid contact with anyone who has encephalitis. Controlling mosquitoes (a mosquito bite can transmit some viruses) may reduce the chance of some infections that can lead to encephalitis.

Apply an insect repellant containing the chemical, DEET when you go outside (but never use DEET products on infants younger than 2 months). Remove any sources of standing water (such as old tires, cans, gutters, and wading pools). Wear long-sleeved shirts and pants when outside, particularly at dusk.

Vaccinate animals to prevent encephalitis caused by the rabies virus. Human vaccinations that are available include:

A vaccination to prevent a form of viral encephalitis that often affects people living in dorms or in the military Herpes zoster Measles

References
1. Aksamit AJ Jr. Acute viral encephalitis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 422. 2. Bleck TP. Arthropod-borne viruses affecting the central nervous system. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 391.

Review Date: 8/1/2012. Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

A.D.A.M., Disclaimer Copyright 2012, A.D.A.M., Inc. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002388/

Elaine Dowell, Encephalitis Society

Symptoms and Diagnosis

Encephalitis means simply 'inflammation of the brain'. It is usually caused by a viral infection. Exposure to viruses can occur through insect bites, food or drink contamination, inhalation of respiratory droplets from an infected person, or skin contact. Common illnesses such as measles and mumps can lead to encephalitis. Although viruses infecting the brain are a major cause of infectious encephalitis, the bodys reaction to an infection can also lead to encephalitis. This condition is called post infectious or autoimmune encephalitis. Initial symptoms of encephalitis

Fever or flu-like illness Headache Vomiting Sensitivity to light Stiff neck and back (occasionally) Confusion, disorientation Behaviour that is out of character Drowsiness Clumsiness, unsteady gait

More serious neurological signs

Poor responsiveness, loss of consciousness, coma Seizures (fits) Muscle weakness or paralysis

A diagnosis of Encephalitis is made following a range of tests which can include:

Lumbar puncture, in which the cerebrospinal fluid is tested for viral particles, especially herpes simplex virus. These tests can also exclude bacterial meningitis. Brain scans (CT or MRI) - to show the extent of any inflammation and to exclude brain tumours, aneurysms and strokes. An electroencephalogram (EEG) will help confirm a diagnosis of encephalitis by recording any unusual patterns of electrical activity in the brain. Blood tests to exclude metabolic encephalopathy.

It should be noted that it is not unusual for the results of some tests to be normal. It is important to initially exclude some more common and treatable diseases. An antiviral medication, Acyclovir, will be prescribed. Acyclovir has significantly improved the outlook in cases of encephalitis caused by the herpes simplex virus, but it is not effective against other viruses. Acyclovir is given usually three times a day by direct infusion into the veins and a long line can be inserted if the drug is to be given for a long period of time. Drugs which stop or prevent seizures (anti-convulsants) may also be given. In severe cases, the child may need to be placed in an Intensive Care Unit so that the doctors can monitor and treat any swelling in the brain. Steroids may be used to reduce inflammation. Antibiotics may

also be prescribed: they are not effective against viruses but will help to prevent a bacterial infection in someone who is seriously ill. Discharge from Hospital Planning for discharge should start from the moment your child is admitted to hospital, and ideally, be managed by a named or key nurse. When it is time for your child to be discharged, you can request a Discharge Planning Meeting to make sure that proper plans, support and care can be provided to meet your childs needs at home. If your child is likely to have continuing health and social care needs, a care plan will be produced. This will identify who will provide the care and support for your child at home. As parents, you are likely to be seen as the primary carers of your child. You should be happy with the plans that are put in place, and if you are not, you need to say so and explain why. You should be convinced that all placements and plans are in place before your child returns home and begins to access the community services. Your childs GP should be advised of the discharge from hospital by letter, which may be sent directly or given to you to hand over. It usually gives information about hospital treatment, medication to be given at home and any follow-up arrangements. A typed discharge summary will usually be provided to the GP and should be received within 10 days of discharge. A Department of Health document Jacks Journey is an exemplar of a pathway through the NHS for a child who has sustained an acquired brain injury. Jacks Journey follows a young boy who has a head injury but the discharge from hospital is also relevant to infections of the brain see page 10 of Jacks Journey. Requesting a second opinion The GP or the hospital doctor can refer you to a different consultant for another opinion of your childs diagnosis or difficulty but they dont have to do this if they dont agree that it is necessary. You can choose to approach a consultant on a private basis, however this can be expensive. If you have a complaint Visit Problems in Hospital. The Patients Association produces a leaflet called Making a Complaint. There is a lot of information in this booklet, you will not need to read it all. It has been designed so that you can select the sections that are relevant to your particular situation. Copies can be obtained from the Patients Association, PO Box 935 Harrow, Middlesex HA1 3YJ Tel: 020 8423 9111 Helpline: 0845 6084455 www.patients-association.com
http://www.encephalitis.info/information/encephalitis-in-children/