Features of viral encephalitis

Sharing is caring!

Features of viral encephalitis

Pathogenesis, clinical features, diagnostic approach, treatment, and common complications of viral encephalitis

Pathogenesis: direct CNS invasion by virus or immune-mediated responseArthropod: inoculation from mosquito → local replication → viremia → infection of cerebral capillary endothelial cells → neurons OR choroid plexus → intraventricular CSF → ventricular ependymal cells → periventricular cerebral tissue (prefer basal ganglia and thalami)
HSV: retrograde axoplasmic flow of virus in the axons of a division of trigeminal nerve → latent infection in the ganglion and reactivation (prefer inferior and medial temporal lobes)
Clinical featuresArthropod: nonspecific, increased lethargy and behavioral changes, or brief single seizures, rashes in WNV, parkinsonian features, poliomyelitis-like syndrome
HSV: subacute fever, headache, behavioral changes, focal seizure activity, and neurologic deficits
VZV: subacute small and large vessel ischemic and hemorrhagic infarctions
Diagnosis, CSF studiesArthropod
CSF: antibody titer or immunoassay
MRI: hyperintense lesions on FLAIR in subcortical areas, basal ganglia
HSV
CSF: +HSV PCR
MRI: hyperintensity on T2 FLAIR sequence in medial and inferior temporal lobe up to insula with CSF correlation, at times hemorrhagic
EEG: PLEDS over temporal lobes
VZV
CSF: antibody titer more sensitive than PCR
MRI: large- and small-vessel ischemic and hemorrhagic infarctions and spherical subcortical white matter lesions
TreatmentArthropod: supportive care and management of neurologic complications; ribavirin for La Crosse virus
HSV: acyclovir 10 mg/kg q 8h × 3 weeks
VZV: acyclovir 10 mg/kg q 8h × 3 weeks
CMV: foscarnet and gancyclovir
Common complicationsSeizures, increased ICP, multifocal neurologic deficits, cognitive impairment, myelitis, death

 View full sizeWNV , West Nile virus; HSV , herpes simplex virus-1; VZV , varicella zoster virus; CNS , central nervous system; CSF , cerebrospinal fluid; VZV , varicella zoster virus; MRI , magnetic resonance imaging; EEG , electroencephalogram; PCR , polymer chain reaction; FLAIR , fluid attenuation inversion recovery; CMV , cytomegalovirus; ICP , intracranial pressure.

Sharing is caring!

You cannot copy content of this page

15585

Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

15856
Scroll to Top