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13 Cards in this Set

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What is encephalitis?
Encephalitis is inflammation of the brain tissue.
What causes encephalitis?
Viral causes predominate, but fungus, rickettsial infection, toxoplasmosis and tuberculosis are also important etiologies.
What is the most important cause of acute encephalitis in the US?
The herpes virus, especially HSV-1.

Note that HSV is an important cause of viral meningitis as well.
What are some rare viral causes of encephalitis?
eastern equine encephalitis, St. Louis encephalitis, rabies and West Nile virus
What type of encephalitis is common in HIV-infected patients with low CD4 counts?
Toxoplasma encephalitis.
What is the mortality rate of untreated HSV encephalitis?
70%
What are the typical clinical features of herpes encephalitis?
1. Fever
2. Nausea
3. Vomiting
4. Headache
5. Alterations in the level of consciousness
6. Lethargy and confusion

HSV can involve the temporal lobe, causing personality change, temporal lobe seizures and odd behavior.

Other symptoms include speech disturbances, ataxia, cranial nerve defects and visual field loss.
T or F: Neurologic sequelae are common in survivors of encephalitis.
T
What testing should be done to evaluate suspected encephalitis?
1. CSF to look for pleocytosis and RBCs. RBCs are frequently present in the CSF.

2. HSV DNA polymerase chain reaction performed on CSF is replacing brain biopsy for diagnosis because it is rapidly performed and highly sensitive and specific.
CSF in patients with HSV encephalitis usually shows a pleocytosis. What does this mean?
It means a high number of both lymphocytes and PMNs. PMNs may predominate early in infection.
How do you treat HSV encephalitis?
High dose IV acyclovir. Because of high mortality rates, begin therapy as soon as you consider the diagnosis.
How do you treat non-HSV encephalitides?
There is no treatment.
T or F: You can't culture HSV from CSF.
True. That is why the DNA PCR for HSV on CSF is the preferred diagnostic test for HSV encephalitis.