Encephalitis

Signs & Symptoms

• Coma – Acute neurological deficit (aphasia, paralysis etc)
• Epilepsy – Confusion
• Might be rapidly worsening

Evaluation

• Brain MRI
• Lumbar puncture after brain imaging: analysis of CSF for white blood cell analysis (ideally including flowcytometry analysis), protein level, glucose level, presence for neoplastic cells
• Infectious workup (incl. viral and bacterial analysis in CSF and blood: according to local practice and epidemiology (eg varicella, hepatitis E, HSV1, HSV2, VZV, EBV, HIV,…):
• Lactate
• EEG
• Autoimmune serology: neuronal surface antibodies and/or intracellular neuronal antibodies according to clinical presentation in the serum (except anti-NMDA R Ab are done on CSF (can be done later, therefore keep CSF)
• ICPi-related encephalitis is an exclusion diagnosis

Management

Treat with following combination:

• 1-2mg/kg methylprednisolone IV
• 10mg/kg 3 x pd acyclovir until PCR for viral infections is negative
• 2gr 3 x pd ceftriaxone, 500mg 3 x pd metronidazole, 2gr 6x pd ampicilline until negative cultures
• ICU admission should be considered and cases should be discussed with a neurologist