Acute Febrile Encephalopathy

Encephalopathy
Infectious diseases:

Metabolic diseases
Toxic disorders Mass lesions

Subarachnoid hemorrhage
Embolic lesions Acute demyelinating disorders: Acute multiple sclerosis
,Acute hemorrhagic leukoencephalitis

Status epilepticus
Postinfectious diseases: GBS, Miller-Fisher syndrome, acute
cerebellar ataxia

Acute confusional migraine

Encephalitis/ Meningoencephalitis
Encephalitis is an inflammation of the brain
Meningoencephalitis is a similar inflammatory

illness in which both the brain and meninges are involved

Etiologic Agents
Viruses

Person to person

Adenoviruses Herpes simplex types 1 and 2 Enteroviruses Mumps Japanese encephalitis Rabies Herpesvirus simiae (herpes B)

Insect bites

Animal to human

 Bacteria

Common

Haemophilus influenzae Neisseria meningitidis Streptococcus pneumoniae Mycobacterium tuberculosis

Spirochetal infections: Leptospirosis, Lyme disease

Chlamydia psittaci, Chlamydia pneumoniae

Rickettsial infections
Mycoplasma Fungal/Protozoal/Helminths

PATHOGENESIS
CNS infection secondary to primary viral infection elsewhere

Directly involve tissue cells within the brain

Vasculitis and liberated toxins

Immune/ Autoimmune response

Encephalitis

Clinical Features
Fever

Headache
Infants- screaming spells behavioral or personality changes Decreased consciousness Gen/ Focal seizures Hemiparesis Movement disorders Cranial nerve defects Ataxia

Investigations
Blood Biochemistry

Funduscopy
Neuroimaging

USS - transfontanelle MRI CT - RADIATION

periodic lateralized epileptiform discharges - Herpes

CSF studies

EEG -

Serology Viral studies: PCR/ Culture

Brain biopsy

Treatment
Supportive

Antiedema

Dexamethasone Mannitol Antibiotics

Specific therapy

Ceftriaxone 100mg/Kg/d Vancomycin 15mg/Kg/d 6hrly Acyclovir 10mg/Kg/d X 3 weeks

Antiviral

Antiepileptic

Complications
Sensorineural hearing defects

Seizures
Loss of milestones Cerebral palsy Dystonias Cognitive impairment Poor scholastic performance Specific learning defects