Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Fever in a traveller |Malaria Falciparum |Malaria Non Falciparum |Viral Haemorrhagic Fevers (VHF) |Lassa fever |Dengue |Marburg virus disease |AIDS HIV |Yellow fever |Ebola Virus |Leptospirosis | Crimean-Congo haemorrhagic fever |African Trypanosomiasis (Sleeping sickness) |American Trypanosomiasis (Chagas Disease) |Incubation Periods |Notifiable Diseases UK |Herpes Simplex Encephalitis (HSV) |Acute Encephalitis
๐ง Acute encephalitis constitutes a neurological emergency. Treatment must be started promptly on the basis of the likely diagnosis. Can occur at any age and HSV can even mimic a Deep MCA stroke. Consider LP and early MRI if considered. Aciclovir should be started if reasonable suspicion until diagnosis excluded when it can be stopped. Aciclovir is not benign and can rarely cause AKI and its use must be balanced with risks and benefits. Always take expert neurology advice.
| ๐ง ๐จ Initial Encephalitis Management Summary |
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| Cause | Clinical Features | Investigations | Treatment |
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| Viral (HSV, VZV, enterovirus) | Fever, headache, confusion, seizures, focal neurology (e.g. aphasia, hemiparesis) | CSF lymphocytosis + PCR, MRI: temporal lobe hyperintensity, EEG: temporal activity | IV Aciclovir + supportive care, anticonvulsants |
| Autoimmune (Anti-NMDA-R) | Psychiatric features, memory loss, seizures, dyskinesias, autonomic instability | CSF oligoclonal bands, serum/CSF antibodies, MRI often normal, EEG diffuse slowing | Steroids, IVIG, plasma exchange ยฑ Rituximab/Cyclophosphamide, treat underlying tumour |
| Bacterial (e.g. Listeria, Mycoplasma) | Fever, headache, confusion, seizures, focal deficits | CSF neutrophils, high protein, low glucose, Gram stain & culture; MRI ยฑ abscess | IV antibiotics (e.g. Ampicillin for Listeria), manage ICP |
| Fungal (Cryptococcus, Aspergillus) | Subacute headache, meningism, cranial nerve palsies | CSF antigen/India ink, MRI nodules or abscesses | Amphotericin B + Flucytosine โ Fluconazole maintenance |