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Chapter 2 : Diagnostic Evaluation

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Diagnostic Evaluation, Page 1 of 2

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Abstract:

The diagnosis of encephalitis is suggested when brain dysfunction is accompanied by evidence of central nervous system (CNS) inflammation. In the elderly, infection of other organ systems such as the lungs or gastrointestinal tract may be followed by fluid and electrolyte imbalance, reduced oxygenation of the blood, and impaired caloric intake. Definition of the specific etiology of a case of encephalitis is important for several reasons. First, by identifying the etiologic agent or mechanism, the patient is spared with therapies and diagnostic maneuvers directed at other potential etiologies. Second, the clinician is able to be more specific in the projection of the possible course and outcome of the illness. Third, the information is of public health importance. The examination and laboratory evaluation of a case of encephalitis is an exercise in both clinical neurology and diagnostic virology. The neurological history, examination, and diagnostic studies can determine the anatomic location of dysfunction in the nervous system, distinguish encephalitis from other categories of disease, and sometimes suggest the specific viral etiology. Virologically oriented studies must proceed in stride with the clinical neurological studies. The need for rapid viral diagnosis is propelled by the increasing number of specific antivirals available for treatment. Dramatic advances in the diagnosis and treatment of acute viral diseases have revolutionized patient care.

Citation: Booss J, Esiri M. 2003. Diagnostic Evaluation, p 21-30. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch2
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Figures

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FIGURE 2.1

First task, exclude alternative diagnoses. MRI of a 4-year-old boy with a history of headache and the acute onset of hemiplegia. CSF revealed a pleocytosis with polymorphonuclear predominance. Axial MRI (T1 weighted with gadolinium) revealed areas of enhancement in parietal occipital lobes. The clinical profile, CSF, and MRI would have been compatible with infection of the brain; however, a full evaluation revealed a migraine syndrome (Goldstein et al., 1990). Courtesy Gordon Sze, Yale University School of Medicine.

Citation: Booss J, Esiri M. 2003. Diagnostic Evaluation, p 21-30. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch2
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FIGURE 2.2

Citation: Booss J, Esiri M. 2003. Diagnostic Evaluation, p 21-30. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch2
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References

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17. Storch, G. A., 2001. Diagnostic virology, p. 495531. In D. M. Knipe,, P. M. Howley,, D. E. Griffin,, R. A. Lamb,, M. A. Martin,, B. Roizman,, and S. E. Straus (ed.), Fields Virology, 4th ed. Lippincott Williams and Wilkins, Philadelphia, Pa.

Tables

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TABLE 2.1

Steps in evaluating suspected viral encephalitis

Citation: Booss J, Esiri M. 2003. Diagnostic Evaluation, p 21-30. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch2
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TABLE 2.2

Clinical classification of encephalitis

Citation: Booss J, Esiri M. 2003. Diagnostic Evaluation, p 21-30. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch2
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TABLE 2.3

Neuroanatomy localization of encephalitis: examples of syndromes and infections

Citation: Booss J, Esiri M. 2003. Diagnostic Evaluation, p 21-30. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch2
Generic image for table
TABLE 2.4

Specimens to be considered in evaluating a case of viral encephalitis

Citation: Booss J, Esiri M. 2003. Diagnostic Evaluation, p 21-30. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch2

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