Pediatric Encephalitis

Rifngatun Nadhiroh*, Tigor Yeheskiel**

* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
Overall, there were 7.3 encephalitis cases per 100,000 neuroimaging with brain parenchymal changes or
person in the US years during 2000– 2010 with peak incidence in electroencephalogram (EEG) consistent with encephalitis. 4,5,6
infants <1 year (13.5 per 100,000) and lowest in children 10– 14 Encephalitis can be diagnosed by CT Scan and laboratory test.
years (4.1 per 100,000). 95% occur in children under 10 years. 2 In this case the patient feel a similar complaint, seizure
A 3-year-old men complained of seizure since the age of 1 experienced by patient arise from the age 1 years, with fever
years, complaints accompanied by fever (>390C), then seizures (>390C), disorientation, deficit neurologist and from physical
occur with a frequency of 1-2 minutes with a resting phase in examination, no abnormaitas were found, this can occur because
each spasm. Seizures usually occur 2-3 times a week. Besides the the patient condition is not possible, meningeal sign negative. CT
central nervous system disorders in the form of muscle weakness Scan revealed a leptomeningeal enhancement picture. 5,6
so that the patient is slow to walk and imbalance in motor Based on patient complaints, the clinical picture and
movements or ataxia. Then, patient comes to the radiology radiological examination support that this encephalitis.
department and undergoes contrast MSCT examination.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363
 Pediatric Encephalitis
Rifngatun Nadhiroh*, Tigor Yeheskiel**
* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background Discussion
Encephalitis is a rare, but serious, condition of neurologic
dysfunction due to inflammation of the brain parenchyma and Brain parenchymal inflammation associated with neurologic
may be caused by infections or autoimmune conditions. dysfunction is the strict definition of confirmed encephalitis.2
Diagnosis is typically made by a combination of clinical, Herpes simplex virus (HSV), varicella-zoster virus (VZV), and
laboratory, neuroimaging, and electrophysiologic findings. To enterovirus are 3 of the most commonly identified etiologic agents
distinguish encephalitis from other causes of encephalopathy, in acute encephalitis. 1
key features include presence of fever, CSF pleocytosis, or MRI or The International Encephalitis Consortium (IEC) created
EEG changes compatible with encephalitis. 1 simplified consensus diagnostic criteria for a standardized case
Computed Tomography (CT), Magnetic Resonance Imaging definition of encephalitis and encephalopathy of presumed
(MRI), laboratory and electrophysiologic findings is infectious or autoimmune etiology.3 Altered mental status for over
recommended for patients with encephalitis. 24 hours without an alternative cause is required as evidence of
neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever
Case Description ≥38°C within 72 hours, seizures, new focal neurologic findings,
cerebrospinal fluid (CSF) pleocytosis (≥5 white blood cells/μL),
neuroimaging with brain parenchymal changes or
electroencephalogram (EEG) consistent with encephalitis. 4,5,6
A 3-year-old men complained of seizure since the age of 1 Encephalitis can be diagnosed by CT Scan and laboratory test.
years, complaints accompanied by fever (>390C), then seizures In this case the patient feel a similar complaint, seizure
occur with a frequency of 1-2 minutes with a resting phase in experienced by patient arise from the age 1 years, with fever
each spasm. Seizures usually occur 2-3 times a week. Besides the (>390C), disorientation, deficit neurologist and from physical
central nervous system disorders in the form of muscle weakness examination, no abnormaitas were found, this can occur because
so that the patient is slow to walk and imbalance in motor the patient condition is not possible, meningeal sign negative. CT
movements or ataxia. Then, patient comes to the radiology Scan revealed a leptomeningeal enhancement picture. 5,6
department and undergoes contrast MSCT examination. Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.

Conclusion Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
Encephalitis results from inflammation of the brain doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014: Original Studies. The Pediatric Infectious
parenchyma. The basic diagnosis of encephalitis is based on Disease Journal • Volume 38, Number 1, January 2019.
clinical manifestations and CT Scan which produces a picture of 4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and Interobserver Agreement: Clinical Radiology. 2016.
leptomeningeal enhancement. 1 5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of The California Encephalitis Project: Pediatric Neurology
52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with updated information and services, is located on the world wide web
at: http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363