Skip to Main Content

++

CONDITION/DISORDER SYNONYMS

++

  • Meningoencephalitis

  • Acute disseminated encephalomyelitis

++

ICD-9-CM CODE

++

  • 323.9 Unspecified cause of encephalitis, myelitis, and encephalomyelitis

++

ICD-10-CM CODE

++

  • G04.90 Encephalitis and encephalomyelitis, unspecified

++

PREFERRED PRACTICE PATTERNS

++

  • 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling1

  • 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—congenital origin or acquired in infancy or childhood2

  • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—acquired in adolescence or adulthood3

  • 5I: Impaired Arousal, Range of Motion and Motor Control Associated with Coma, Near Coma, or Vegetative State4

++

PATIENT PRESENTATION

Three weeks after a regimen of cyclosporine to treat his psoriasis, a 42-year-old man developed a fever, headache, and nausea that were unresponsive to medication or position change. Within a few days he struggled with balance and gait ataxia and became progressively more disoriented. By the end of the week he was comatose, with Glasgow Coma Scale score of 5. Magnetic resonance imaging (MRI) reveals mediotemporal lobe necrosis. The patient is placed on intravenous acyclovir.

++

KEY FEATURES

++
Description
++

  • Infection of the brain parenchyma

  • Most commonly results in infection of the entire brain, but some viruses attack specific nervous system structures

++
Essentials of Diagnosis
++

  • May occur with meningitis; some overlap of signs and symptoms

  • Two primary forms: Viral and bacterial

  • Postinfectious encephalitis: Autoimmune reaction to systemic viral infection

  • Causative factor must be identified to initiate appropriate medical treatment prior to physical therapy involvement

  • Common forms include

    • Herpes simplex encephalitis (most common cause of sporadic encephalitis in adults)

    • Arboviral encephalitis (most common epidemic forms): West Nile virus, Eastern and Western equine encephalitis, and rabies

++
FIGURE 86-1

Viral encephalitis, showing perivascular lymphocytic cuffing. (From Chandrasoma P, Taylor CR. Concise Pathology. 3rd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
++
General Considerations
++

  • Rapid differential diagnosis of encephalitis versus meningitis should be made due to similarities of initial symptoms and response to medication.

  • Severity may progress over a period of 1 week; PT should monitor for changing neurologic signs and symptoms, refer accordingly.

++
Demographics
++

  • Approximately 20,000 cases of acute viral encephalitis are reported annually in the United States.

  • Death occurs in 5% to 20%.

  • All ages and genders are susceptible; some forms are more common in specific geographic locations.

++
FIGURE 86-2

CT (A) and diffusion-weighted MRI (B) scans of the brain of a patient with left-temporal-lobe HSV encephalitis. (From Longo DL, Fauci AS, Kasper DL, et al., eds. Harrison’s Principles of Internal Medicine...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.