Pathophysiology
1) infection and inflammation of brain parenchyma 2) sometimes occurs with meningeal and spinal cord involvement
Signs and Symptoms
1) high fever 2) headache (often severe) 3) stiff neck 4) mental status changes (from lethargy to confusion/delirium/hallucinations to coma) 5) seizures 6) focal neurological deficits – ataxia, aphasia, hemiparesis, ocular palsies
Characteristic Test Findings
Lumbar puncture – 1) CSF findings – identical to viral meningitis: increased lymphoctyes, normal glucose (except in mumps, which is decreased), and normal or slightly elevated protein 2) diagnosis is by CSF PCR
Histology/Gross Pathology
1) inflammatory exudate with lymphoctyic infiltration of small arteries and veins 2) hemorrhage 3) in herpes simplex 1, temporal lobes are more often affected 4) in Epstein-Barr cases, atypical lymphocytes are found in brain parenchyma
Associated Conditions
1) herpes simplex type 1 2) varicella 3) enteroviruses 4) mumps 5) arboviruses – easter equine, western equine, Venezuelan, California viruses 6) west Nile virus
Inheritance/Epidemiology
20,000 cases/year in USA
Treatment
1) acyclovir empirically until herpes simplex virus type 1 is ruled out 2) ganciclovir and foscarnet in CMV 3) ribavirin in California (LaCrosse) virus 4) prophylactic antiseizure medications 5) fluid restriction
Tips for USMLE
1) eastern equine virus is usally the most severe 2) mumps is unusual among viral encephalitis because glucose is decreased instead of normal 3) neurologic findings are usually more dramatic and acute than in bacterial causes
I read the above, and the History, as well as associated condition (Choices) seems to fit my husbands findings.
My husband has received ZERO treatment … He has had MRI’s, a spinal tap, and various examinations by Neurologists….
Because his attack was over 20 years ago, his gait has gotten worse. The original attack centered on his lower legs, and they became “rubbery” with a need to “hold the walls” as he would attempt to walk. Now he uses a walker…
Is there anything other than possibly Thiamine and Potassium, that I could give him in the way of supplements? I give him Salmon Oil capsules and “Move Free” for inflammation.