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BCM 225
NEUROENDOCRINE MEDICINE
BCM/K/0005/2021
ENCEPHALITIS
Introduction;Definition
• Encephalitis is the inflammation of brain.
• It can be ;
• Primary encephalitis –virus directly infects the brain and spinal cord.
• Secondary encephalitis –Infection starts elsewhere in the body and
then travels to the brain.
Causes;
• a)Common viruses- includes Herpes simplex, mumps, Epstein Barr
Viru, HIV, Cytomegalovirus.
• b)Childhood viruses – includes Chicken pox, measles, rubella etc.
• c)Arboviruses – includes California virus, S.t Lous virus, West Nile
virus, Colorado virus etc.
Viral encephalitis;
• Commonest cause is Herpes simplex.
• Also arboviruses.
• Risk factors include;old age, children and immunocompromised
patients like HIV/AIDS.
Pathophysiology;
• Infection provokes an inflammatory response.
• Involves cortex, white matter, basal ganglia, and brainstem.
• Distribution of lesions varies.
• In Herpes simplex, temporal lobes are affected.
• In Cytomegalovirus, areas adjacent to ventricles are affected
(ventriculitis).
• Inclusion bodies present in neurons and glial cells.
• Infiltration of polymorphonuclear cells in perivascular space.
• Also, neuronal degeneration and diffuse glial proliferation.
Clinical presentation;
• Acute onset of headache, fever, focal neurological signs like
aphasia, hemiplegia, and visual field defect.
• Seizures, altered level of consciousness.
• Coma
• Meningism may also occur. Involves; neck stiffness, photophobia,
nausea and vomiting.
• In children,it presents with vomiting, bulging fontanel, constant
cough, body stiffness and poor appetite.
• Also, behavioral changes may occur.
Clinical features ;continued
• In severe cases;
• Drowsiness
• Hallucination
• Prostrations
• Coma
• Seizures
• Irritability
• Photophobia
• Difficulties in speaking
Diagnosis;
• Imaging tests include;
• CT scan of the head – shows low density lesions in temporal
lobes.
• MRI – more sensitive and can reveal early abnormalities.
• Lumber puncture; CSF examination;
• Excess lymphocytes, normal glucose level….
• Also, PCR can reveal the cause.
• Electroencephalography; abnormal in early stages.
Diagnosis criteria;
• Major criteria; Subacute onset of consciousness impairment,
impaired memory, mental status and also new onset of
psychiatric changes without alternative cause.
• Minor criteria;
• 1.Fever > 38 * C within 72 hrs before and after presentation.
• 2.Seizures
• 3.CSF pleocytosis
• 4.Evidence of brain parenchyma inflammation on neuroimaging.
DDx.
• Hemorrhagic stroke
• Subarachnoid hemorrhage
• Hyper/hypoglycemia
• Hyponatraemia
• Uremia
• Frontal lobe epilepsy
• Sub/epidural hemorrhage
• Sinus thrombosisSUbclinical
• Status epilepticus
Management;
• Supportive treatment;
• IV fluids in dehydration
• Mechanical ventilation
• Pain relievers
• Anticonvulsants
Management,continued;
• Specific treatment;
• Antivirals, especially Aciclovir 10 mg/kg TID for 21 days IV in
cases of Herpes simplex.
• Dexamethasone in raised intracranial pressure.
Rehabilitation;
• Physiotherapy
• Occupational therapy
• Speech therapy
• Psychotherapy
Complications;
• Epilepsy
• Cognitive impairment
• Impaired movement
• Interllectual disability
• Paralysis
• Coma
• Behavioral changes
• Speaking problems
• Vision problems
• Loss of memory
• Death
References;
• Davidson’s Principles and Practice of Medicine
• “Mayoclinic.org,”
End;
THANK YOU ………………………………………………

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ENCEPHALITIS.pptx

  • 2. Introduction;Definition • Encephalitis is the inflammation of brain. • It can be ; • Primary encephalitis –virus directly infects the brain and spinal cord. • Secondary encephalitis –Infection starts elsewhere in the body and then travels to the brain.
  • 3. Causes; • a)Common viruses- includes Herpes simplex, mumps, Epstein Barr Viru, HIV, Cytomegalovirus. • b)Childhood viruses – includes Chicken pox, measles, rubella etc. • c)Arboviruses – includes California virus, S.t Lous virus, West Nile virus, Colorado virus etc.
  • 4. Viral encephalitis; • Commonest cause is Herpes simplex. • Also arboviruses. • Risk factors include;old age, children and immunocompromised patients like HIV/AIDS.
  • 5. Pathophysiology; • Infection provokes an inflammatory response. • Involves cortex, white matter, basal ganglia, and brainstem. • Distribution of lesions varies. • In Herpes simplex, temporal lobes are affected. • In Cytomegalovirus, areas adjacent to ventricles are affected (ventriculitis). • Inclusion bodies present in neurons and glial cells. • Infiltration of polymorphonuclear cells in perivascular space. • Also, neuronal degeneration and diffuse glial proliferation.
  • 6. Clinical presentation; • Acute onset of headache, fever, focal neurological signs like aphasia, hemiplegia, and visual field defect. • Seizures, altered level of consciousness. • Coma • Meningism may also occur. Involves; neck stiffness, photophobia, nausea and vomiting. • In children,it presents with vomiting, bulging fontanel, constant cough, body stiffness and poor appetite. • Also, behavioral changes may occur.
  • 7. Clinical features ;continued • In severe cases; • Drowsiness • Hallucination • Prostrations • Coma • Seizures • Irritability • Photophobia • Difficulties in speaking
  • 8. Diagnosis; • Imaging tests include; • CT scan of the head – shows low density lesions in temporal lobes. • MRI – more sensitive and can reveal early abnormalities. • Lumber puncture; CSF examination; • Excess lymphocytes, normal glucose level…. • Also, PCR can reveal the cause. • Electroencephalography; abnormal in early stages.
  • 9. Diagnosis criteria; • Major criteria; Subacute onset of consciousness impairment, impaired memory, mental status and also new onset of psychiatric changes without alternative cause. • Minor criteria; • 1.Fever > 38 * C within 72 hrs before and after presentation. • 2.Seizures • 3.CSF pleocytosis • 4.Evidence of brain parenchyma inflammation on neuroimaging.
  • 10. DDx. • Hemorrhagic stroke • Subarachnoid hemorrhage • Hyper/hypoglycemia • Hyponatraemia • Uremia • Frontal lobe epilepsy • Sub/epidural hemorrhage • Sinus thrombosisSUbclinical • Status epilepticus
  • 11. Management; • Supportive treatment; • IV fluids in dehydration • Mechanical ventilation • Pain relievers • Anticonvulsants
  • 12. Management,continued; • Specific treatment; • Antivirals, especially Aciclovir 10 mg/kg TID for 21 days IV in cases of Herpes simplex. • Dexamethasone in raised intracranial pressure.
  • 13. Rehabilitation; • Physiotherapy • Occupational therapy • Speech therapy • Psychotherapy
  • 14. Complications; • Epilepsy • Cognitive impairment • Impaired movement • Interllectual disability • Paralysis • Coma • Behavioral changes • Speaking problems • Vision problems • Loss of memory • Death
  • 15. References; • Davidson’s Principles and Practice of Medicine • “Mayoclinic.org,”