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  • Meningoencephalitis
  • Acute disseminated encephalomyelitis

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  • 323.9 Unspecified cause of encephalitis, myelitis, encephalomyelitis

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  • G04.90 Encephalitis and encephalomyelitis, unspecified

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Description

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

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Essentials of Diagnosis

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  • May occur with meningitis; some overlap of signs and symptoms
  • Two primary forms: viral and bacterial
  • Post-infectious 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 in adults: sporadic encephalitis)
    • Arboviral encephalitis
      • Most common epidemic forms: West Nile virus, Eastern and Western equine encephalitis, rabies

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General Considerations

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  • Rapid differential diagnosis of encephalitis vs. 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

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Demographics

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  • 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 susceptible; some forms more common in specific geographic locations

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Signs and Symptoms

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  • Fever
  • Headache
  • Nuchal rigidity
  • Vomiting
  • General malaise
  • Coma
  • Cranial nerve palsy
  • Hemiplegia
  • Involuntary movements
  • Ataxia

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Functional Implications

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  • Inability to perform ADLs independently
  • Loss of independent functional mobility
  • Inability to perform age and education appropriate cognitive tasks
  • Inability to execute fine and gross motor tasks independently

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Possible Contributing Causes

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  • Increased risk to individuals who are
    • Immunosuppressed
    • Perinatal to early childhood period
  • Prior meningitis

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Differential Diagnosis

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  • Stroke
  • Subdural empyema
  • Cerebral abscess
  • Cerebral venous thrombosis
  • Septic embolism
  • Meningitis

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Laboratory Tests

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  • Cerebral spinal fluid testing
  • Intracranial pressure

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Imaging

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  • CT scan for detailed imaging
  • MRI with gadolinium enhancement

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Medications

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  • To ER if encephalitis suspected
  • To neurologist during infection and for follow-up
  • To physician for respiratory therapy if source of infection is pulmonary in origin
  • To occupational therapist for ADL- and cognitive-retraining
  • To social worker for case management

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  • Arousal
  • Attention
  • Behavior
  • Cognition
  • ...

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