Understanding and managing acute encephalitis.
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TLDR
The most important infectious cause in the West is herpes simplex virus, but globally Japanese encephalitis (JE) remains the single largest cause and various forms of immunotherapy are used for AIE.Abstract:
Encephalitis is an important cause of morbidity, mortality, and permanent neurologic sequelae globally. Causes are diverse and include viral and non-viral infections of the brain as well as autoimmune processes. In the West, the autoimmune encephalitides are now more common than any single infectious cause, but, in Asia, infectious causes are still more common. In 2006, the World Health Organization coined the term “acute encephalitis syndrome”, which simply means acute onset of fever with convulsions or altered consciousness or both. In 2013, the International Encephalitis Consortium set criteria for diagnosis of encephalitis on basis of clinical and laboratory features.
The most important infectious cause in the West is herpes simplex virus, but globally Japanese encephalitis (JE) remains the single largest cause. Etiologic diagnosis is difficult because of the large number of agents that can cause encephalitis. Also, the responsible virus may be detectable only in the brain and is either absent or transiently found in blood or cerebrospinal fluid (CSF). Virological diagnosis is complex, expensive, and time-consuming. Different centres could make their own algorithms for investigation in accordance with the local etiologic scenarios. Magnetic resonance imaging (MRI) and electroencephalography are specific for few agents. Clinically, severity may vary widely. A severe case may manifest with fever, convulsions, coma, neurologic deficits, and death.
Autoimmune encephalitis (AIE) includes two major categories: (i) classic paraneoplastic limbic encephalitis (LE) with autoantibodies against intracellular neuronal antigens (Eg: Hu and Ma2) and (ii) new-type AIE with autoantibodies to neuronal surface or synaptic antigens (Eg: anti-N-methyl-D-aspartate receptor). AIE has prominent psychiatric manifestations: psychosis, aggression, mutism, memory loss, euphoria, or fear. Seizures, cognitive decline, coma, and abnormal movements are common. Symptoms may fluctuate rapidly.
Treatment is largely supportive. Specific treatment is available for herpesvirus group and non-viral infections. Various forms of immunotherapy are used for AIE.read more
Citations
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TL;DR: In this article , the authors estimate the spatiotemporal patterns of the encephalitis burden along with its attributable risk factors at the national, regional, and global levels, which may be helpful in guiding targeted prevention and treatment programs.
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An atypical case of febrile infection-related epilepsy syndrome following acute encephalitis: impact of physiotherapy in regaining locomotor abilities in a patient with neuroregression.
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TL;DR: GluCEST will provide new insight into encephalitis and help improve the differential diagnosis of brain disorders and the GluC EST imaging signal has potential as an in vivo imaging biomarker for the early diagnosis ofEncephalitis.
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References
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A clinical approach to diagnosis of autoimmune encephalitis
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TL;DR: Through logical differential diagnosis, levels of evidence for autoimmune encephalitis (possible, probable, or definite) are achieved, which can lead to prompt immunotherapy.
Journal ArticleDOI
Paraneoplastic anti–N‐methyl‐D‐aspartate receptor encephalitis associated with ovarian teratoma
Josep Dalmau,Erdem Tüzün,Hai-Yan Wu,Jaime Masjuan,Jeffrey E. Rossi,Alfredo Voloschin,Joachim M. Baehring,Haruo Shimazaki,Reiji Koide,Dale King,Warren P. Mason,Lauren H Sansing,Marc A. Dichter,Myrna R. Rosenfeld,David A. Lynch +14 more
TL;DR: The autoantigens of a new category of treatment‐responsive paraneoplastic encephalitis are reported, and it is proposed that this category should be combined with existing treatment-responsive encephalopathy categories.
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The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America
Allan R. Tunkel,Carol A. Glaser,Karen C. Bloch,James J. Sejvar,Christina M. Marra,Karen L. Roos,Barry J. Hartman,Sheldon L. Kaplan,W. Michael Scheld,Richard J. Whitley +9 more
TL;DR: The guideline includes data on the epidemiology, clinical features, diagnosis, and treatment of many viral, bacterial, fungal, protozoal, and helminthic etiologies of encephalitis and provides information on when specific etiologic agents should be considered in individual patients with encephalopathy.
Journal ArticleDOI
Case Definitions, Diagnostic Algorithms, and Priorities in Encephalitis: Consensus Statement of the International Encephalitis Consortium
Arun Venkatesan,Allan R. Tunkel,Karen C. Bloch,Adam S. Lauring,James J. Sejvar,Ari Bitnun,Jean-Paul Stahl,Alexandra Mailles,M. Drebot,Charles E. Rupprecht,Jonathan S. Yoder,Jennifer R. Cope,Michael R. Wilson,Richard J. Whitley,John S. Sullivan,Julia Granerod,Cheryl A Jones,Keith Eastwood,Katherine N. Ward,Katherine N. Ward,David N Durrheim,M. V. Solbrig,L. Guo-Dong,Carol A. Glaser,Heather Sheriff,David W. Brown,Eileen C. Farnon,Sharon Messenger,Beverley J. Paterson,Ariane Soldatos,Sharon L. Roy,Govinda S. Visvesvara,Michael L. Beach,Roger S. Nasci,Carol Pertowski,Scott Schmid,Lisa Rascoe,Joel M. Montgomery,Suxiang Tong,Robert F. Breiman,Richard Franka,Matt Keuhnert,Fred Angulo,James D. Cherry +43 more
TL;DR: A consensus document is presented that proposes a standardized case definition and diagnostic guidelines for evaluation of adults and children with suspected encephalitis and will serve as a practical aid to clinicians evaluating patients with suspectedEncephalitis.
Journal ArticleDOI
Beyond Viruses: Clinical Profiles and Etiologies Associated with Encephalitis
Carol A. Glaser,Somayeh Honarmand,Lydia Anderson,David P. Schnurr,Bagher Forghani,C K Cossen,Frederick L. Schuster,Laura J. Christie,Jay H. Tureen +8 more
TL;DR: The recognition of discrete clinical profiles among patients with encephalitis should help focus efforts toward understanding the etiology, pathogenesis, course, and management of this complex syndrome.