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Encephalitis

Definition

Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections.

Causes

Encephalitis is a rare condition. It occurs more often in the first year of life and decreases with age. The very young and older adults are more likely to have a severe case.

Encephalitis is most often caused by a viral infection. Many types of viruses may cause it. Exposure to viruses can occur through:

  • Breathing in respiratory droplets from an infected person
  • Contaminated food or drink
  • Mosquito, tick, and other insect bites
  • Skin contact

Different viruses occur in different locations. Many cases occur during a certain season.

Encephalitis caused by the herpes simplex virus is the leading cause of more severe cases in all ages, including newborns.

Routine vaccination has greatly reduced encephalitis due to some viruses, including:

Other viruses that cause encephalitis include:

After the virus enters the body, the brain tissue swells. This swelling may destroy nerve cells, and cause bleeding in the brain and brain damage.

Other causes of encephalitis may include:

  • An allergic reaction to vaccinations
  • Autoimmune disease
  • Bacteria such as Lyme disease, syphilis, and tuberculosis
  • Parasites such as roundworms, cysticercosis, and toxoplasmosis in AIDS patients and other people who have a weakened immune system
  • The effects of cancer

Symptoms

Some people may have symptoms of a cold or stomach infection before encephalitis symptoms begin.

When this infection is not very severe, the symptoms may be similar to those of other illnesses:

  • Fever that is not very high
  • Mild headache
  • Low energy and a poor appetite

Other symptoms include:

Symptoms in newborns and younger infants may not be as easy to recognize:

  • Body stiffness
  • Irritability and crying more often (these symptoms may get worse when the baby is picked up)
  • Poor feeding
  • Soft spot on the top of the head may bulge out more
  • Vomiting

Emergency symptoms:

Exams and Tests

An examination may show:

  • Abnormal reflexes
  • Increased intracranial pressure
  • Mental confusion
  • Mouth ulcers
  • Muscle weakness
  • Neck stiffness
  • Signs in other organs, such as the liver and lungs
  • Skin rash
  • Speech problems

Tests may include:

  • Brain MRI
  • CT scan of the head
  • Culture of cerebrospinal fluid (CSF), blood, or urine (however, this test is rarely useful)
  • Electroencephalogram (EEG)
  • Lumbar puncture and CSF examination
  • Tests that detect antibodies to a virus (serology tests)
  • Test that detects tiny amounts of virus DNA (polymerase chain reaction -- PCR)

Treatment

The goals of treatment are to provide supportive care (rest, nutrition, fluids) to help the body fight the infection, and to relieve symptoms.

Medications may include:

  • Antiviral medicines, if a virus caused the infection
  • Antibiotics, if bacteria is the cause
  • Antiseizure medicines to prevent seizures
  • Steroids to reduce brain swelling
  • Sedatives for irritability or restlessness
  • Acetaminophen for fever and headache

If brain function is severely affected, physical therapy and speech therapy may be needed after the infection is controlled.

Outlook (Prognosis)

The outcome varies. Some cases are mild and short, and the person fully recovers. Other cases are severe, and permanent problems or death is possible.

The acute phase normally lasts for 1 to 2 weeks. Fever and symptoms gradually or suddenly disappear. Some people may take several months to fully recover.

Possible Complications

Permanent brain damage may occur in severe cases of encephalitis. It can affect:

  • Hearing
  • Memory
  • Muscle control
  • Sensation
  • Speech
  • Vision

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have:

  • Sudden fever
  • Other symptoms of encephalitis

Prevention

Children and adults should avoid contact with anyone who has encephalitis.

Controlling mosquitoes (a mosquito bite can transmit some viruses) may reduce the chance of some infections that can lead to encephalitis.

  • Apply an insect repellant containing the chemical, DEET when you go outside (but do not use DEET products on infants younger than 2 months).
  • Remove any sources of standing water (such as old tires, cans, gutters, and wading pools).
  • Wear long-sleeved shirts and pants when outside, especially at dusk.

Children and adults should get routine vaccinations for viruses that can cause encephalitis. People should receive specific vaccines if they are traveling to places such as parts of Asia, where Japanese encephalitis is found.

Vaccinate animals to prevent encephalitis caused by the rabies virus.

References

Beckham JD, Tyler KL. Encephalitis. In: Bennett JE, Dolin R, Mandell GL, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 91.

Simon DW, Da Silva YS, Zuccoli G, Clark RSB. Acute encephalitis. Crit Care Clin. 2013;29:259-277.


Review Date: 8/30/2014
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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