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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***[[Enteroviruses]] |
***[[Enteroviruses]] |
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***[[Eastern equine encephalitis|Eastern]] or [[Western equine encephalitis]], [[Japanese encephalitis]], [[Murray Valley encephalitis]], [[St. Louis encephalitis]], [[West Nile virus]] |
***[[Eastern equine encephalitis|Eastern]] or [[Western equine encephalitis]], [[Japanese encephalitis]], [[Murray Valley encephalitis]], [[St. Louis encephalitis]], [[West Nile virus]] |
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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]]) |
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*Non-infectious (including post-infectious) |
*Non-infectious (including post-infectious) |
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**Acute disseminated encephalomyelitis (ADEM) |
**[[Acute disseminated encephalomyelitis]] (ADEM) |
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**Vasculitis |
**[[Vasculitis]] |
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**Collagen vascular disorders |
**[[Collagen vascular disorders]] |
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**Paraneoplastic syndromes |
**[[Paraneoplastic syndromes]] |
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*'''Cryptogenic in 50-70%''' |
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==Investigations== |
==Investigations== |
Revision as of 22:04, 12 August 2020
- 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
- Bacteria
- Other
- 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