- Encephalitis –
Inflammation of the brain parenchyma.
RISK GROUP AGE
< 1 y.o infants and in elderly > 65 y.o with intermediate incidence in individuals between these age extremes
SOURCES OF INFECTIONS
Swelling and patchy hemorrhagic areas.
Most marked in right temporal lobe.
ETIOLOGI
- Viruses (herpes virus, rabies virus, arboreal viruses, cytomegalovirus, etc.);
- Bacteria often occurring as meningoencephalitis caused by meningococci,
pneumococci
- Hemophilus, tuberculous bacteria, etc.
- Fungi or parasites such as leptospirosis, toxoplasmosis, trichinellosis, etc.
The most common incubation period is 3-5 days.
GEJALA KLINIS
A subacute progression of fever
hemicranial headache
behavioral abnormalities
focal seizure activity, and focal neurologic deficits
most often dysphasia or hemiparesis
least often; joint pain, irritability, lethargy, behavioral changes.
First exposure is usually asymptomatic, but in some individuals, vesicular lesions develop in the mouth. (HSV Encephalitis)
KLASIFIKASI
Primary and secondary encephalitis;
o Primary: the brain and spinal cord are directly affected.
o Secondary: the infection enters the brain after affecting another organ.
Berdasarkan tempat lesi nya ; o Polyoencephalitis – localized in the gray matter of the brain/spinal cord;
o Leucoencephalitis – localized in the cerebral white brain matter;
o Panencephalomyelitis – localized in the gray and white matter of the brain/spinal cord;
o Perivenous encephalomyelitis.
PX. PENUNJANG
GOLD STANDARD u/ Encephalitis :
Pungsi Lumbal: The classic abnormalities are;
CSF analysis demonstrates a lymphocytic pleocytosis with a normal or rarely mildly decreased glucose concentration. There may be RBC or xanthochromia in the CSF because this is a necrotizing encephalitis.
PCR Assay: PCR assay for HSV-1 has a sensitivity and specificity of
> 95%.
The CSF HSV PCR may be (-) in the first 72 H of symptoms of HSV encephalitis. HSV antibodies can be detected in the CSF bout 8 - 12 days after symptom onset and for as long as 3 months.
Axial T2 (left) and coronal T2 (right) MRIs showing marked asymmetric T2 hyperintense gyral cortical and juxtacortical white matter edema within the
anteromedial left temporal lobe and parahippocampal gyrus
TREATMENT
Acyclovir, and is usually administered IV in the hospital for at least 10 days.
MODES OF TRANSMISSION
Breathing in respiratory droplets from an infected person
Skin contact
Mosquito, tick, and other insect bites
Tick of Horses
Migratory Birds
Contaminated food or drink COMPLICATIONS
The major complications of encephalitis;
o Memory problems
o Personality and behavioral changes
o Speech problems o Epilepsy
o Physical and motor difficulties o Low mood
o Fatigue
o Altered Mental Status
Skin discoloration or rash are absent
PROGNOSIS Dubia ad Bonam.
Encephalitis still leads to death in about 10% of patients. Depends on the virulency level of the virus itself.
Survivors of severe cases of encephalitis can be left with permanent problems such as;
fatigue, irritability, impaired concentration, seizures, hearing loss, memory loss and blindness.
Diana Fadhilah Sari - Notes
Diana Fadhilah Sari - Notes
