Encephalitis – Diagnosis and Treatment
Diagnosis
Diagnosing encephalitis often begins with a review of the patient’s symptoms. Common complaints include fever, headache, confusion, nausea, vomiting, and sometimes seizures.
Signs such as a stiff neck, memory loss, drowsiness, weakness, irritability, lethargy, and loss of appetite can also appear. In some cases, people may notice sensitivity to light, mental confusion, or even fall into a coma.
Doctors use a physical exam to check for symptoms and signs of infection or brain inflammation. Next, several tests help identify the condition and its causes:
Diagnostic Tools
| Test | What It Checks For |
|---|---|
| MRI or CT scan | Brain swelling, tumors, or other causes of neurological disease. |
| Lumbar Puncture (Spinal Tap) | Infection, inflammation, and the specific cause in the CSF. |
| EEG (Electroencephalogram) | Abnormal electrical activity or seizure patterns. |
| Lab Tests (Blood, Urine, Stool, Throat) | Viruses, bacteria, or signs of infection. |
| Body Imaging (Ultrasound, MRI, CT, PET-CT) | Tumors that may affect the brain. |
| Brain Biopsy | Direct examination of brain tissue, used when other tests don’t help. |
Typical Steps in the Process
- Check symptoms like fever, headaches, vomiting, and mental confusion.
- Run blood or spinal tap tests for infection.
- Use imaging tests like MRI or CT scans to find brain changes.
- Record brain activity with an EEG for seizure signs.
- Use biopsy only if other tests fail and the illness worsens.
Doctors focus on early detection. They quickly look for signs of brain inflammation, meningitis, febrile illness, and other neurological symptoms to start treatment as soon as possible. They may regularly monitor intracranial pressure if severe symptoms develop.
Treatment
Use of Medications Against Viruses
Doctors often use antiviral therapy when a viral cause of encephalitis is suspected. This treatment targets certain viruses, such as herpes simplex virus (HSV), Epstein-Barr virus, cytomegalovirus, and other herpes viruses. Starting antiviral therapy early can help prevent severe complications.
A nucleoside analog antiviral is typically used initially, even before test results confirm the specific virus. This approach ensures early treatment for infections like HSV encephalitis, which can progress rapidly without prompt care.
However, for some viruses—such as those transmitted by mosquitoes or ticks (including West Nile virus or tick-borne encephalitis virus)—antiviral medications are not effective, and treatment focuses on supportive care.
Doctors carefully monitor patients on antiviral therapy since some medications may affect kidney function, although most side effects are mild.
Common Antiviral Medicines Table
| Medicine Name | Common Uses |
|---|---|
| Nucleoside Analog Antiviral | HSV, Epstein-Barr virus |
| Classified Antiviral | Cytomegalovirus, other herpes viruses |
| Pyrophosphate Analog Antiviral | Resistant viral infections |
Treatments for Immune System-Related Inflammation
When autoimmune conditions cause encephalitis, doctors use medications that modify the immune system’s response.
These treatments may include corticosteroids to quickly reduce brain swelling, intravenous immunoglobulin (IVIG) to help regulate immune activity, and plasma exchange to remove harmful antibodies from the blood.
Some patients may need longer-term treatment with immunosuppressive medications to control ongoing immune system attacks. These therapies can involve agents such as antimetabolites, B-cell–depleting monoclonal antibodies, or interleukin-6 receptor blockers.
If an underlying tumor is contributing to the autoimmune process, doctors may recommend surgery, chemotherapy, or radiation therapy to remove or shrink the tumor and reduce immune system activation.
Care to Ease Symptoms and Support the Patient
Supportive care plays a vital role, especially for those hospitalized with severe symptoms. Medical staff may use a breathing machine if the patient cannot breathe well on their own.
IV fluids help maintain hydration and healthy mineral levels. Medicines such as corticosteroids can help reduce swelling and pressure inside the skull. If someone has seizures, doctors give anti-seizure drugs.
Ongoing Help and Recovery Therapy
After the main treatment, patients may experience lasting effects from encephalitis. Doctors often recommend therapy focused on recovery, which can include:
- Physical therapy for building muscle strength, balance, and movement.
- Occupational therapy to assist with daily activities and improve self-care.
- Speech therapy for those with trouble talking or swallowing.
- Brain rehabilitation programs to help with memory, thinking, and concentration.
- Psychological counseling for coping with mood, personality, or behavior changes.
Therapists tailor rehabilitation to each person, aiming to help them return to daily life.
Getting Ready for Your Visit
What Your Health Provider May Ask
During a visit about possible encephalitis, the healthcare provider usually asks some questions to help find the cause. Some topics may include:
- When the first signs or symptoms began
- Any new medicines you have started recently, including names and reasons
- Whether you have had any mosquito or tick bites, which can spread illnesses
- Places you have traveled recently, including areas with risks like rabies or insect bites
- Any recent illnesses, such as a cold, chickenpox, or cold sores
- Whether you are current on vaccines, such as for varicella-zoster, rabies, and others
- Contact with wild animals or possible toxins
- Sexual health, for example, unprotected sex or exposure to infections like syphilis
- Any health conditions or treatments that lower your immune system
- Whether autoimmune diseases are present or common in your family
Write down this information before the visit. Bring a list of all current medicines, recent vaccines, and any possible exposures (for example, tick bites or mosquito bites). Discuss good hygiene and using insect repellent with DEET with your provider.
