Encephalitis

Diagnosis

Diagnosing encephalitis typically entails a thorough examination of the individual’s medical history, a comprehensive physical assessment to understand the presenting symptoms, a neurological examination to assess brain function, and a battery of tests aimed at confirming or excluding the presence of encephalitis.

The tests that may be requested include:

• Lumbar puncture or spinal tap: This procedure involves collecting a sample of spinal fluid for laboratory analysis. During the procedure, a thin needle is used to withdraw a small portion of cerebrospinal fluid (CSF) from the lower back, which is the protective fluid around the brain and spinal column. Detecting alterations in this fluid can indicate potential brain infections or inflammation. In certain cases, the collected samples can be examined to determine the underlying cause, which might involve screening for infections, or the presence of antibodies linked to autoimmune encephalitis. 
• Brain imaging: Brain swelling or any disorder that may be causing the symptoms, like a tumor, can be seen in an MRI or CT scan.
• Body imaging: To screen for tumors, imaging tests like MRIs, CT scans, CT–PET scans, or ultrasounds could examine the pelvic, abdomen, or chest. If a mass is discovered, a little portion of it might be taken out for examination, also known as biopsy. An unusual immune reaction to a cancerous or benign tumor in the body can occasionally cause autoimmune encephalitis. 
• Other lab tests: Testing for viruses or other pathogens can be performed on samples of blood, urine, or excretions from the back of the throat.
• Electroencephalogram (EEG): If specific unusual patterns are detected during an EEG, it could suggest a diagnosis of encephalitis. The electrical activity of the brain is recorded using electrodes attached to the scalp during the test.
• Brain biopsy: A brain biopsy is only considered when the treatments are ineffective, and when the symptoms are deteriorating. A tiny sample of brain tissue may be taken for examination.

Treatment

The treatment approach for encephalitis varies depending on its specific type and severity. The effects of treatments for viral and autoimmune encephalitis may become apparent within a few days, but for brain recovery may take time.

For mild encephalitis, the treatment typically focuses on easing symptoms like headaches and fever. This is usually accomplished through a combination of rest, increased fluid intake, and the use of anti–inflammatory medications such as acetaminophen, ibuprofen, or naproxen sodium.

• Antiviral medicines: Antiviral medications are generally well–tolerated and are used to treat encephalitis brought on by specific viruses, with rare instances of potential side effects like kidney damage.

Common antiviral medications for treating encephalitis include acyclovir, ganciclovir and foscarnet. Acyclovir may be prescribed to treat herpes simplex virus (HSV), which if not treated right away, can lead to serious consequences. However, these medicines are ineffective against some viruses, such as those transmitted by insects. 

In some cases, since the precise virus may not be promptly or conclusively identified, healthcare providers often recommend immediate treatment with acyclovir.

• Autoimmune encephalitis: Oral or intravenous corticosteroids, intravenous immunoglobulin, and plasma exchange are among the immunomodulatory medications and treatments that target the immune system beneficial in treating autoimmune encephalitis. Rituximab, tocilizumab, azathioprine, and mycophenolate mofetil may be prescribed to certain individuals dealing with autoimmune encephalitis that are required of extended therapy using immunosuppressive medications.

Surgery, radiation, chemotherapy, or a combination of therapies may be recommended to treat tumors that are the source of autoimmune encephalitis. 

• Supportive care: Supportive care is crucial for individuals hospitalized with severe encephalitis. This care may encompass several vital aspects, including assistance with breathing and vigilant monitoring of both breathing and heart function. 

To alleviate swelling and pressure within the skull, anti–inflammatory medications like corticosteroids may be prescribed. Anticonvulsant medications such as phenytoin may be administered to either halt or prevent seizures. Intravenous fluids are administered to maintain proper hydration and essential mineral levels.

• Ongoing treatment: Some symptoms may become permanent for some people. Complications may develop which may require extra treatment. One can adjust to changes in their abilities with the aid of rehabilitation.

Follow–up therapy may include brain training to enhance memory and cognition, and speech therapy to retrain the muscles used to create speech. Other therapies that are needed include:

• • Physical therapy: This is to increase mobility, balance, flexibility, strength, and motor coordination.
  • Occupational therapy: It aimed at honing everyday skills and the use of adaptive aids for daily activities.
  • Psychotherapy: Deals with personality changes or treating mood disorders and develops coping mechanisms and new behavioral skills.