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Encephalitis

What is encephalitis?

Encephalitis is an inflammation of the brain tissue. The most common cause is viral infections. In rare cases it can be caused by bacteria or even fungi.

There are two main types of encephalitis: primary and secondary. Primary encephalitis occurs when a virus directly infects the brain and spinal cord. Secondary encephalitis occurs when an infection starts elsewhere in the body and then travels to your brain.

Encephalitis is a rare yet serious disease that can be life-threatening. You should call your doctor immediately if you have symptoms of encephalitis.

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Symptoms

What are the symptoms of encephalitis?

The symptoms of encephalitis can range from mild to severe.

Mild symptoms include:

  • fever
  • headache
  • vomiting
  • stiff neck
  • lethargy (exhaustion)

Severe symptoms include:

  • fever of 103°F (39.4°C) or higher
  • confusion
  • drowsiness
  • hallucinations
  • slower movements
  • coma
  • seizures
  • irritability
  • sensitivity to light
  • unconsciousness

Infants and young children show different symptoms. Call a doctor immediately if your child is experiencing any of the following:

  • vomiting
  • bulging fontanel (soft spot in the scalp)
  • constant crying
  • body stiffness
  • poor appetite

Causes

What causes encephalitis?

Many different viruses can cause encephalitis. It’s helpful to categorize the potential causes into three groups: common viruses, childhood viruses, and arboviruses.

Common viruses

The most common virus that causes encephalitis in developed countries is herpes simplex. The herpes virus typically travels through a nerve to the skin, where it causes a cold sore. In rare cases, however, the virus travels to the brain.

This form of encephalitis usually affects the temporal lobe, the part of the brain that controls memory and speech. It can also affect the frontal lobe, the part that controls emotions and behavior. Encephalitis caused by herpes is dangerous and can lead to severe brain damage and death.

Other common viruses that can cause encephalitis include:

  • mumps
  • Epstein-Barr virus
  • HIV
  • cytomegalovirus

Childhood viruses

Vaccines can prevent the childhood viruses that used to cause encephalitis. Therefore, these types of encephalitis are rare today. Some childhood viruses that can cause encephalitis include:

Arboviruses

Arboviruses are viruses carried by insects. The type of arbovirus that’s transmitted depends on the insect. Below are different types of arboviruses:

  • California encephalitis (also called La Crosse encephalitis) is transmitted through mosquito bites and mainly affects children. It causes few to no symptoms.
  • St. Louis encephalitis occurs in the rural Midwest and southern states. It’s generally a mild virus and causes few symptoms.
  • West Nile virus is most often found in Africa and the Middle East. However, it can occur in the United States. It’s usually relatively mild, causing flu-like symptoms. However, it can be fatal among older adults and people with weak immune systems.
  • Colorado encephalitis (also called Colorado tick fever) is transmitted by the female wood tick. It’s typically a mild disease, and most people will recover quickly.
  • Eastern equine encephalitis is spread by mosquitoes. It affects both humans and horses. Although rare, it has a 33 percent mortality rate.
  • Kyasanur forest disease is transmitted through tick bites. People can also get it by drinking raw milk from goats, sheep, or cows. Hunters, campers, and farmers are most at risk for getting this disease.
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Risk factors

What are the risk factors for encephalitis?

The groups most at risk of encephalitis are:

  • older adults
  • children under the age of 1
  • people with weak immune systems

You may also have a higher risk of getting encephalitis if you live in an area where mosquitos or ticks are common. Mosquitos and ticks can carry viruses that cause encephalitis. You’re more likely to get encephalitis in the summer or fall when these insects are most active.

Although the MMR (measles, mumps, rubella) vaccine has a long history of being safe and effective, in rare cases it has caused encephalitis. Approximately 1 in 3 million children who receive the vaccine develop encephalitis. However, the statistics are much more striking for children who don't receive the vaccine. Rates of encephalitis in the days before routine vaccination reached as high as 1 in 1,000. In other words, encephalitis was roughly 3,000 times more common before vaccination was available.

Diagnosis

How is encephalitis diagnosed?

Your doctor will first ask you about your symptoms. They may perform the following tests if encephalitis is suspected.

Spinal tap or lumbar puncture

In this procedure, your doctor will insert a needle into your lower back to collect a sample of spinal fluid. They will test the sample for signs of infection.

Brain imaging with CT scan or MRI

CT scans and MRI detect changes in brain structure. They can rule out other possible explanations for symptoms, such as a tumor or stroke. Certain viruses have a tendency to affect certain areas of the brain. Seeing what parts of your brain are affected can help determine what type of virus you have.

Electroencephalograph (EEG)

An EEG uses electrodes (small metal discs with wires) attached to the scalp to record brain activity. An EEG does not detect the virus that causes encephalitis, but certain patterns on the EEG may alert your neurologist to an infectious source of your symptoms. Encephalitis can lead to seizures and coma in later stages. That's why the EEG is important in determining the areas of the brain that are affected and the types of brain waves that occur in each area.

Blood tests

A blood test can reveal signs of a viral infection. Blood tests are rarely performed alone. They usually help diagnose encephalitis along with other tests.

Brain biopsy

In a brain biopsy, your doctor will remove small samples of brain tissue to test for infection. This procedure is rarely performed because there’s a high risk of complications. It’s usually only done if doctors can’t determine the cause the brain swelling or if treatment isn’t working.

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Treatment

How is encephalitis treated?

Anti-viral medications can help treat herpes encephalitis. However, they aren’t effective in treating other forms of encephalitis. Instead, treatment often focuses on relieving symptoms. These treatments may include:

  • rest
  • pain killers
  • corticosteroids (to reduce brain inflammation)
  • mechanical ventilation (to help with breathing)
  • lukewarm sponge baths
  • anticonvulsants (to prevent or stop seizures)
  • sedatives (for restlessness, aggressiveness, and irritability)
  • fluids (sometimes through an IV)

You may need to be hospitalized during treatment, especially with brain swelling and seizures.

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Complications

What are the complications associated with encephalitis?

Most people who are diagnosed with severe encephalitis will experience complications. Complications resulting from encephalitis can include:

  • loss of memory
  • behavioral/personality changes
  • epilepsy
  • fatigue
  • physical weakness
  • intellectual disability
  • lack of muscle coordination
  • vision problems
  • hearing problems
  • speaking issues
  • fatigue
  • coma
  • difficulty breathing
  • death

Complications are more likely to develop in certain groups, such as:

  • older adults
  • people who have had coma-like symptoms
  • people who didn’t get treatment right away
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Outlook

What is the long-term outlook for someone with encephalitis?

Your outlook will depend on the severity of the inflammation. In mild cases of encephalitis, the inflammation will likely resolve in a few days. For people who have severe cases it may require weeks or months for them to get better. It can sometimes cause permanent brain damage or even death.

People with encephalitis may also experience:

  • paralysis
  • loss of brain function
  • problems with speech, behavior, memory, and balance

Depending on the type and severity of encephalitis, it may be necessary to receive additional therapy, including:

  • physical therapy: to improve strength, coordination, balance, and flexibility
  • occupational therapy: to help redevelop everyday skills
  • speech therapy: to help relearn muscle control needed for talking
  • psychotherapy: to help with coping strategies, mood disorders, or personality changes

Prevention

Can encephalitis be prevented?

Encephalitis isn’t always preventable, but you can lower your risk by getting vaccinated for viruses that can cause encephalitis. Also make sure your children receive vaccinations for these viruses. In areas where mosquitos and ticks are common, use repellant, and wear long sleeves and pants. If you're traveling to an area that's known for viruses that cause encephalitis, check the Centers for Disease Control and Prevention (CDC) website for vaccination recommendations.

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