Encephalitis: Difference between revisions
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==Differential Diagnosis== |
==Differential Diagnosis== |
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+ | *Common causes include [[HSV]], [[VZV]], and [[enterovirus]] in developed countries |
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+ | *Consider [[rabies virus]], [[Japanese encephalitis virus]], [[West Nile virus]], [[tickborne encephalitis virus]], and [[St. Louis encephalitis virus]] depending on travel history |
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*Infectious |
*Infectious |
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**Viruses |
**Viruses |
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+ | ***[[Herpes simplex encephalitis|Herpes simplex virus]] |
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⚫ | |||
+ | ***[[Varicella-zoster virus]] |
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⚫ | |||
⚫ | |||
⚫ | |||
***[[Rabies virus]] |
***[[Rabies virus]] |
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***[[Hendra virus]] |
***[[Hendra virus]] |
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***[[Nipah virus]] |
***[[Nipah virus]] |
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− | ***[[Tickborne encephalitis]], [[La Crosse virus]], [[Powassan virus]] |
+ | ***[[Tickborne encephalitis virus]], [[La Crosse virus]], [[Powassan virus]] |
**Bacteria |
**Bacteria |
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***''[[Mycoplasma pneumoniae]]'' |
***''[[Mycoplasma pneumoniae]]'' |
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***''[[Toxoplasma gondii]]'' |
***''[[Toxoplasma gondii]]'' |
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***''[[Bayliscarias procyonis]]'' |
***''[[Bayliscarias procyonis]]'' |
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− | ***Prion disease ([[CJD]]) |
+ | ***[[Prion disease]] ([[CJD]]) |
*Non-infectious (including post-infectious) |
*Non-infectious (including post-infectious) |
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− | **Acute disseminated encephalomyelitis (ADEM) |
+ | **[[Acute disseminated encephalomyelitis]] (ADEM) |
− | **Vasculitis |
+ | **[[Vasculitis]] |
− | **Collagen vascular disorders |
+ | **[[Collagen vascular disorders]] |
− | **Paraneoplastic syndromes |
+ | **[[Paraneoplastic syndromes]] |
+ | *'''Cryptogenic in 50-70%''' |
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==Investigations== |
==Investigations== |
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*EEG is rarely helpful except to rule out non-convulsive status epilepticus |
*EEG is rarely helpful except to rule out non-convulsive status epilepticus |
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− | === |
+ | ===MRI=== |
{| class="wikitable" |
{| class="wikitable" |
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!Finding |
!Finding |
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|- |
|- |
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|space-occupying lesions |
|space-occupying lesions |
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− | |[[Toxoplasma gondii]], [[Balamuthia mandrillaris]], [[Acanthamoeba |
+ | |[[Toxoplasma gondii]], [[Balamuthia mandrillaris]], [[Acanthamoeba]], [[Taenia solium]] |
|- |
|- |
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|subependymal enhancement |
|subependymal enhancement |
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==Management== |
==Management== |
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− | * |
+ | *Empiric [[acyclovir]] 10 mg/kg IV q8h for suspected HSV or VZV encephalitis |
+ | *Add [[doxycycline]] if [[Rickettsiae|rickettsiosis]] or [[ehrlichiosis]] is possible |
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[[Category:CNS infections]] |
[[Category:CNS infections]] |
Latest revision as of 12:46, 25 January 2022
- Infection of the brain parenchyma causing clouding of the sensorium
- Some overlap with meningitis
Differential Diagnosis
- Common causes include HSV, VZV, and enterovirus in developed countries
- Consider rabies virus, Japanese encephalitis virus, West Nile virus, tickborne encephalitis virus, and St. Louis encephalitis virus depending on travel history
- Infectious
- Viruses
- Herpes simplex virus
- Varicella-zoster virus
- Enteroviruses
- Eastern or Western equine encephalitis virus, Japanese encephalitis virus, Murray Valley encephalitis virus, St. Louis encephalitis virus, West Nile virus
- Rabies virus
- Hendra virus
- Nipah virus
- Tickborne encephalitis virus, La Crosse virus, Powassan virus
- Bacteria
- Other
- Viruses
- Non-infectious (including post-infectious)
- Cryptogenic in 50-70%
Investigations
- Lumbar puncture for viral culture or PCR
- MRI is the best neuroimaging; CT if MRI not available
- EEG is rarely helpful except to rule out non-convulsive status epilepticus
MRI
Management
- Empiric acyclovir 10 mg/kg IV q8h for suspected HSV or VZV encephalitis
- Add doxycycline if rickettsiosis or ehrlichiosis is possible