Acute Encephalitis – symptoms, diagnosis, treatment
Can be produced either by direct invasion followed by destruction of brain tissue by an infectious agent or antigen-antibody reaction of the general course of an infection or a toxic effect occurred during a general infectious diseases.
In terms of pathology, encephalitis is characterized by disseminated lesions in gray and white substance of the brain.
After predominantly lesions, encephalitis is classified as follows:
– Polio-encephalitis – lesions predominate in gray substance;
– Leuco-encephalitis – predominant lesions in white matter;
– Pan-encephalitis – lesions are disseminated both in gray substance and in white matter.
The clinical picture of acute encephalitis is polymorphic.
Incubation varies from 7 days to 2-3 weeks, depending on the etiology.
Onset is sudden with high fever, generalized or focal seizures, headache, chills, vomiting, crying modified (squeal). Gradually, on the foreground is installed the cerebral edema symptoms: headache, intense nausea, vomiting, irritability.
During the state, besides the increase of the signs of generally infection, more clearly outlines the signs of reaching the brain:
– Cortical lesions – is characterized by alterations in psyche, agitation alternating with drowsiness, delirium, located convulsions followed by coma, it can install various types of paralysis, and a series of involuntary movements;
– Brainstem lesions – translate into cranial nerve palsy (facial, vestibular, ocular, phonation and swallowing disorders, respiratory disorders);
– Signs of meningeal irritation (the membranes surrounding the brain and spinal cord, that are from outside to inside: dura mater, arachnoid and pia mater) – are the stiffness of the neck, the position “cock of the gun” , lumbar muscle contraction and lower limbs muscle contraction.
Analysis and investigations in encephalitis
Investigations necessary to support the diagnosis of acute encephalitis include:
– Lumbar puncture followed by biochemical analysis of CSF (cerebrospinal fluid);
– Examination of the eye fundus may reveal papillary stasis, optic atrophy;
– EEG (electroencephalogram) – are characteristic changes;
– Serological investigations.
The disease is usually severe, depending on the causative agent. The evolution of acute encephalitis varies. Sometimes it starts with minor clinical symptoms and quickly degenerates into a coma and exitus (death), the clinical picture is sometimes dominated by hyperthermia (fever) and seizures that heal without sequelae or minor sequelae.
The highest percentage of mortality is made by primitive acute viral encephalitis. After healing, encephalitis can leave a series of severe mental and motor sequelae.
Treatment of acute encephalitis
Treatment aims to control intracranial hypertension and cerebral edema (hypertonic solutions with glucose and / or mannitol), anti-seizure (Diazepam followed by phenobarbital), electrolyte balance and fluids (continuous infusion of solutions with glucose and electrolytes) desobstruction of the upper respiratory tract and infection prophylaxis.
Prognosis is reserved. Unfavorable prognosis is potentiated by young child.