Encephalitis: Difference between revisions
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+ | *Infection of the brain parenchyma causing clouding of the sensorium |
− | * |
+ | *Some overlap with [[meningitis]] |
− | == |
+ | ==Differential Diagnosis== |
− | * |
+ | *Infectious |
− | ** |
+ | **Viruses |
− | *** |
+ | ***[[Enteroviruses]] |
− | *** |
+ | ***[[Eastern equine encephalitis|Eastern]] or [[Western equine encephalitis]], [[Japanese encephalitis]], [[Murray Valley encephalitis]], [[St. Louis encephalitis]], [[West Nile virus]] |
− | *** |
+ | ***[[Rabies virus]] |
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+ | ***[[Hendra virus]] |
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+ | ***[[Nipah virus]] |
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+ | ***[[Tickborne encephalitis]], [[La Crosse virus]], [[Powassan virus]] |
− | ** |
+ | **Bacteria |
− | *** |
+ | ***''[[Mycoplasma pneumoniae]]'' |
− | *** |
+ | ***''[[Listeria monocytogenes]]'' |
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+ | ***''[[Borrelia burgdorferi]]'' (Lyme disease) |
− | *** |
+ | ***''[[Coxiella burnetii]]'' |
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+ | ***''[[Bartonella henselae]]'' or ''[[B. quintana]]'' |
− | ** |
+ | **Other |
− | *** |
+ | ***''[[Cryptococcus neoformans]]'' |
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+ | ***''[[Toxoplasma gondii]]'' |
− | *** |
+ | ***''[[Bayliscarias procyonis]]'' |
− | *** |
+ | ***Prion disease ([[CJD]]) |
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+ | *Non-infectious (including post-infectious) |
− | ** |
+ | **Acute disseminated encephalomyelitis (ADEM) |
− | ** |
+ | **Vasculitis |
− | ** |
+ | **Collagen vascular disorders |
− | ** |
+ | **Paraneoplastic syndromes |
− | == |
+ | ==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 === |
+ | {| class="wikitable" |
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+ | !Finding |
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+ | !Differential Diagnosis |
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+ | |- |
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+ | |arteritis and infarctions |
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+ | |[[Varicella-zoster virus]], [[Nipah virus]], [[Rickettsia rickettsii]], [[Treponema pallidum pallidum]] |
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+ | |- |
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+ | |calcifications |
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+ | |[[CMV]] (cortical), [[Toxoplasma]] (periventricular), [[Taenia solium]] |
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+ | |- |
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+ | |cerebellar lesions |
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+ | |[[VZV]], [[EBV]], [[Mycoplasma pneumoniae]] |
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+ | |- |
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+ | |basal ganglia, thalamus, or brainstem lesions |
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+ | |[[EBV]], [[eastern equine encephalitis virus]], [[Murray Valley encephalitis virus]], [[St. Louis encephalitis virus]], [[Japanese encephalitis virus]], [[West Nile virus]], [[enterovirus]] A71, [[influenza virus]], [[prion disease]], [[Tropheryma whipplei]], [[Listeria monocytogenes]] |
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+ | |- |
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+ | |hydrocephalus |
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+ | |[[Mycobacterium tuberculosis]], [[Cryptococcus neoformans]], [[Coccidioides immitis]], [[Histoplasma capsulatum]], [[Balamuthia mandrillaris]] |
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+ | |- |
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+ | |space-occupying lesions |
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+ | |[[Toxoplasma gondii]], [[Balamuthia mandrillaris]], [[Acanthamoeba species]], [[Taenia solium]] |
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+ | |- |
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+ | |subependymal enhancement |
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+ | |[[CMV]] |
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+ | |- |
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+ | |temporal or frontal lobe involvement |
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+ | |[[HSV]], [[VZV]], [[HHV-6]], [[West Nile virus]], [[enterovirus]], [[Treponema pallidum pallidum]] (medial lobes) |
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+ | |- |
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+ | |white matter abnormalities |
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+ | |[[VZV]], [[CMV]], [[EBV]], [[HHV-6]], [[HIV]], [[Nipah virus]], [[JC virus]], [[measles virus]], [[Baylisascaris procyonis]], [[acute disseminated encephalomyelitis]] |
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+ | |} |
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+ | ==Management== |
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+ | |||
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[[Category:CNS infections]] |
[[Category:CNS infections]] |
Revision as of 18:00, 12 August 2020
- Infection of the brain parenchyma causing clouding of the sensorium
- Some overlap with meningitis
Differential Diagnosis
- Infectious
- Viruses
- Bacteria
- Other
- Cryptococcus neoformans
- Toxoplasma gondii
- Bayliscarias procyonis
- Prion disease (CJD)
- Non-infectious (including post-infectious)
- Acute disseminated encephalomyelitis (ADEM)
- Vasculitis
- Collagen vascular disorders
- Paraneoplastic syndromes
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
- Acyclovir for suspected HSV or VZV encephalitis