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  • Meningoencephalitis
  • Acute disseminated encephalomyelitis

  • 323.9 Unspecified cause of encephalitis, myelitis, encephalomyelitis

  • G04.90 Encephalitis and encephalomyelitis, unspecified

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
  • 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

General Considerations

  • 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

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 susceptible; some forms more common in specific geographic locations

Signs and Symptoms

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

Functional Implications

  • 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

Possible Contributing Causes

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

Differential Diagnosis

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

Laboratory Tests

  • Cerebral spinal fluid testing
  • Intracranial pressure

Imaging

  • CT scan for detailed imaging
  • MRI with gadolinium enhancement

Medications

  • 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

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

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