Encephalitis: Symptoms, Cause, Types, And Treatment

Encephalitis is the inflammation of the brain that disturbs your neurophysiological functions and completely change your personality that changes your mood, feelings, and movements. In this context, you will find out about brain changes and also other things that can signal the other problems, its different types, symptoms that increase the chances of developing these diseases, diagnosis of encephalitis that needs medical care, and its treatment. But keep in mind this content is provided complete guidance or information about encephalitis and changes that occur in your brain. If you have any queries, you should concern with your doctor. 

Overview:

Encephalitis is the medical term which means inflammation of brain and brain tissues. It is a rare condition that affects one out of 1000 cases of measles. Often encephalitis causes mild flu symptoms (such as headache and fever), and severe symptoms consist of confused thinking or problem in movements while sometimes having no symptoms. Encephalitis is a severe problem that causes a change in personality, with weakness, seizures (electrical disturbance in the brain that changes mood, feeling, and movements), and others depend on which area is affected in the brain. Encephalitis is caused by various viral infections that weaken the immune system, and sometimes it is also known as viral encephalitis. The people who are suffering from this condition hopefully recover.

In some cases, it becomes life-threatening, and the appropriate changes in the patient’s recovery depend on its severity and the virus that is involved and causes inflammation in the brain. Encephalitis frequently causes only flu-like symptoms (such as a fever or headache) while sometimes no symptoms at all. Sometimes the flu-like symptoms are more severe. Encephalitis also causes confused thinking, seizures, or problems with movements.

Pathophysiology of Encephalitis:

Inflammation of the brain tissues presents as focal or diffuse neuropsychological dysfunction. Even though it predominantly involves the brain, but it frequently involves meninges. In encephalitis, edema, inflammation, or swelling occurs in affected areas of the brain throughout the cerebral hemisphere, cerebellum, brain stem, rarely spinal cord. The portal entry is a virus that is transmitted by humans in most of the cases of Herpes Simplex Virus (HVS) that are reactivated by HSV lying dormant in trigeminal ganglia (sensory ganglion of that trigeminal nerve). Mostly mosquitoes inoculate the arbovirus that is transferred by an animal bite or by the exposure of secretion of animals. Varicella-Zoster virus (VZV) and Cytomegalovirus (CMV) are the immune-compromised viruses which are necessary for developing encephalitis.  

Generally, the virus is replicated from the outside of CNS, and it gets entre by the spreading of hematogenous or transportable by the help of neural pathways. Once this virus crosses the bloodstream or the barrier of the brain, the portal entry of the virus comes in neural cells as a result of a disturbance in the function of cells. This impact on the perivascular congestion, as a result of illnesses that diffuse the inflammatory response and badly affect gray matter over a white matter. Regional tropism relates to the virus because of receptors of the neuron cell membrane that are mostly found in the brain portion and appear with intense focal pathology in that area, as a result of this invasion the virus damages the brain part and neurons. 

What is the response of the immune system in encephalitis?

If once the virus makes the portal entry in the bloodstream, then they start to replicate themselves and spread all over an area of your body that weakens your immune system, including spinal cord and brain damages. When the virus reaches the blood-brain barrier, suddenly the virus slips inside brain cells as a result of damages, disrupts, and ruptures of infected brain cells. 

Then the cell of your immune system rushes the brain and starts attacking your immune system as a result of this caused brain swelling and the body fight against the infection that caused viral. 

Types of Encephalitis:

Generally, encephalitis is the serious problem and it can be classified into four types as according to its severity, these are:

Mumps Meningoencephalitis: 

Mumps is a common virus that mostly affects the brain or the central nervous system (CNS), and it needs consideration for the diagnosis of meningitis. Mump meningoencephalitis is benign that appears with symptoms of irritation of meninges for 4-5 days after the differential diagnosis and finding in cerebrospinal fluid that is distinctive with leukocytes measured more significant than 200 per ml.

Postvaccinal Encephalitis: 

This type of encephalitis relates to the vaccination means with the vaccinia virus during worldwide smallpox. These are the diseases that are usually caused by the unknown etiology that are mostly occurring without any known factors except vaccination against smallpox. The mortality rate of these diseases is approximately 43% that is related to the pathological changes of the brain. 

Measles Encephalitis: 

Measles encephalitis are of different types that occur at different intervals of onset, these are:

Post-Infectious Encephalomyelitis: 

This condition is related to demyelination and is considered an auto-immune basis in which an infectious virus is found in the brain. Post-infection encephalomyelitis is termed as acute disseminated encephalomyelitis due to several categories of inflammation in the central nervous system.

Acute Measles Encephalitis: 

This type of encephalitis occurs in immune-compromised patients either during or after the measles infection after infection of the brain with the virus. This type of encephalitis is distinguished by acute neurological deterioration, seizures, and neurological damage.

Subacute Sclerosing Panencephalitis:

This is also known as Dawson disease. These diseases occur due to the progression of chronic brain inflammation with a defective strain of hyper-mutated measles. This type of encephalitis affected the children at the age of two. 

Hemorrhagic Encephalitis:

This is also known as acute hemorrhagic leukoencephalitis, Weston Hurst syndrome, and Hurst disease. This is a rare form of demyelinating disease. This disease is characterized as an acute inflammation of white matter.

This is also classified as the primary or secondary type of encephalitis.

  • Primary Encephalitis- Primary encephalitis is known as infectious encephalitis that is caused by the virus, fungus, and bacteria of the brain.
  • Secondary Encephalitis- Secondary encephalitis is also known as post-infectious encephalitis in which your immune system starts to respond to previous infections and unintentionally attacks the brain. 

What are the symptoms of encephalitis?

The symptoms of the encephalitis depend on its severity and sudden onset which includes, 

Less common symptoms of encephalitis: 

The people who are suffering from encephalitis are less commonly have neck stiffness (nuchal rigidity) that is becoming the cause of misdiagnoses of encephalitis. Stiffness of limbs and problems in movement also occur as less common symptoms, and patients come with drowsiness abs cough.

More Severe Symptoms: 

Most people who have encephalitis have severe types of symptoms, and they experience nausea, confusion, loss of memory, the problem in hearing, hallucinations, and seizure. In most of the cases, patients of encephalitis also faced aggression and speech problems.

Encephalitis: Symptoms, Cause, Types, And Treatment 1 - Daily Medicos

Others:

 The other symptoms of encephalitis which patient have to face are, 

  • Fever.
  • Lethargy (pathological state of lacking energy.
  • Drowsiness (tired and feel sleepy).
  • Changes in personality (person faced anxiety, depression, anger, irritation).
  • Irritability (feeling agitated and frustrated).
  • Emotional disturbance.
  • Weakness appears in one or more than one area of the body
  • Seizures (electrical imbalance of neurons).
  • Bulging of soft spots (appears tumor or mass in the head).
Encephalitis: Symptoms, Cause, Types, And Treatment 2 - Daily Medicos

What are the common viral causes of encephalitis?

Herpes Simplex Virus (HSV)– Herpes simplex virus are two types of virus that produce viral infection, these are:

  1. HSV-1- Herpes Simplex Virus-1, also known as Human Alphaherpvirus-1 that produces cold sores, blisters, and fever in the mouth. 
  2. HSV-2- Herpes Simplex Virus-2, also known as Human alphaherpesvirus-2 that produces genital herpes that causes encephalitis. This is the rare cause of encephalitis, but it causes severe damage to the brain. 
  3. Other Herpes Virus- Other herpes viruses include Epstein- Barr virus that is mostly caused by the mononucleosis infection and varicella-zoster virus that is caused by chickenpox.
  4. Enteroviruses- The enterovirus is the virus that includes poliovirus that causes illness and weakens the immune system with symptoms of flu, fever, and inflammation of the eye that cause encephalitis.
  5. Mosquito-borne virus- Mosquito-borne virus are the viruses that mostly cause infections for at least 7-8days and cause encephalitis.
  6. Tick-Borne Virus- Tick-borne virus is the powassan virus that becomes the cause of encephalitis that appears after a few days because of bites of infected ticks.
  7. Childhood Infections- Childhood infections such as measles and mumps, become the cause of secondary encephalitis.
Encephalitis: Symptoms, Cause, Types, And Treatment 3 - Daily Medicos

What are the diagnoses of Encephalitis?

There is the differential diagnosis for diagnosed encephalitis which your doctor suggest after taking history and doing a physical examination and they recommended,

  1. Lab Test- Lab analysis helps your doctor to diagnose encephalitis, which includes blood samples, urine tests. Or your mouth excretion is also tested to evaluate viruses and other infections.
  2. Brain Scan– Brain imaging helps your doctor to visualize whether you have encephalitis or any other problem (such as brain tumor, strokes, and brain aneurysm). Generally, there are two types of brain imaging. CT scan or MRI that help to evaluate the condition of your brain.
  3. Lumbar Puncture-Lumbar punctures, also known as spinal tap in which needles are inserted in your back area to remove the cerebrospinal fluid. Variations in CSF mostly indicate the inflammation and infection in your brain. CSF is tested for knowing any infectious agent.
  4. Electroencephalogram (EEG)- In electroencephalogram electrodes are placed in your scalp for recording the activity of the brain and their normal pattern that helps to diagnose encephalitis.
  5. Biopsy- Brain biopsy is performed very rarely in which a sample is taken from the tissue of the brain for testing. The biopsy is suggested when the symptoms become worsening, and no treatment can be affected by the patient.
Encephalitis: Symptoms, Cause, Types, And Treatment 4 - Daily Medicos

Treatment of Encephalitis:

The treatment of encephalitis is based on its severity and the condition of the patient. The treatment of encephalitis start after knowing the cause of and the possible treatment includes,

  1. Treatment for Mild Encephalitis- The mild encephalitis treatment usually consists of bed rest and plenty of fluids. At the same time, Anti-inflammatory drugs are also recommended for patients who come with mild encephalitis. 
  2. Anti-inflammatory drugs- The anti-inflammatory drugs are acetaminophen (such as Tylenol), Ibuprofen (such as Advil, Motrin IB, and others), and Naproxen sodium (such as Aleve) to relieve the fever and headache.
  3. Antiviral Drugs- The encephalitis is caused by some viruses that need antiviral treatment to treat the major cause of encephalitis. This medicine is prescribed when the HSV and chickenpox cause encephalitis. This medicine is usually given for the patients three times a day for 2-3 weeks. 

Antiviral medications include Acyclovir (Zovirax), Foscarnet (Foscavir), and Ganciclovir (Cytovene). These medications are generally tolerated without any side effects, but rarely does it include side effects of kidney damages.

But some of the viruses such as insect-borne viruses usually do not respond to the antiviral treatment. Still, that type of viruses do not visualize immediately, and doctors frequently recommend acyclovir treatment immediately because this medication is very effective to treat HSV.

  1. Antifungal Medication- Antifungal medication is recommended for patients who are suffering from secondary encephalitis that is caused by any bacterial or fungal infection.
  2. Steroidal Injections- Steroidal injections are recommended for the patients of encephalitis who are coming with the problem of the immune system and chickenpox viruses. This treatment was given for a few days.
  3. Plasmapheresis- Plasmapheresis is the procedure in which the liquid part of your blood is separated from your blood cells and replaced by other solutions (such as albumin or saline). After treating the plasma, it returns to the body. This process is done to remove the agents or substances that damage or attack the brain from your blood.
  4. Surgery– The surgery is recommended for removing tumours or abnormal growth that occur in the brain. The operation is needed when the encephalitis is not getting effective results after treatment with medications, and when it starts triggering by the tumour growth in the body.
Encephalitis: Symptoms, Cause, Types, And Treatment 5 - Daily Medicos

Provide Supportive Care: 

Supportive care is a major part of any treatment that is provided to patients who are hospitalized. The patients who are suffering from a severe type of encephalitis also needed supportive care; these are:

  • Proper intravenous fluid is given to ensure the hydration of the patient and to balance the essential mineral in the body.
  • Assistance the breathing pattern and as well as proper monitoring of the patient’s breathing rate and their heart function.
  • Provide corticosteroids to the patients for reducing the pain, swelling, and the pressure that is built in the skull.
  • Also, give anticonvulsant medications to encephalitis patients to prevent the patient from seizures.
  • Mobilized the patient. 
  • Provide oxygen to support the lungs ability.

Are follow-up therapy needed for encephalitis patients?

Yes, follow-up must be needed for encephalitis patients. In some cases, no treatment proves effective for the patients, and they experience complications, so additional therapies required to treat the patient such as,

  1. Physical Therapy-Physical therapy needed for the patient who suffered from encephalitis to improve their strength provides flexibility and balances the posture. It also helps to balance the motor coordination and mobility.
  2. Speech therapy- Speech therapy needed to control the muscles and control their coordination to produce the speech.
  3. Occupational Therapy- This is needed to enhance the personality changes and for developing everyday skills by using adaptive products to enhance daily activities.
  4. Psychotherapy- This therapy needed to learn the behavioural skills and re-correct the mood disorders that address your personality changes
Encephalitis: Symptoms, Cause, Types, And Treatment 6 - Daily Medicos

Before You Leave:

Encephalitis is the medical term that refers to inflammation of the brain and brain tissues. This is a serious problem that changes your personality and mood that appear with symptoms of seizure, weakness, and movement problems. The people with encephalitis hopefully recover, but sometimes it becomes life-threatening. Your doctor diagnosed this condition with the help of brain imaging, lumbar puncture, and an electroencephalogram. The treatment of this disease includes anti-viral, anti-inflammatory, and antifungal medications. This condition is also treated by follow-up therapy and supportive care of the patients. If the drug does not treat encephalitis, then your doctor suggested a biopsy, and it must be needed surgery. 

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