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3 Management Decisions in Acute Encephalitis

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Abstract:

Rapidly progressing encephalitis may confront the clinician with urgent problems in management at the time of presentation or soon thereafter. Intervention to control increased intracranial pressure (ICP) or some other urgent problem may be initiated before the specific cause of an encephalitis has been discovered. Many management problems are common to various forms of encephalitis, as discussed in this chapter. The treatment of viral encephalitis has benefited from developments in four areas in recent years. First, the number of antiviral and immunomodulating therapies has multiplied. Second, technologies for rapid and sensitive virus diagnosis have emerged, including point of care diagnostic kits, IgM capture methodologies to facilitate presumptive diagnosis based on an early single sample, and most dramatically, cerebrospinal fluid (CSF) PCR identification of infectious agents. Third, dramatic improvements in imaging technology, particularly magnetic resonance imaging (MRI), have increased the capacity to track the evolution and response to treatment of central nervous system (CNS) infections and immune-mediated disorders. Fourth, the development of neurointensive care units with advances in physiological monitoring and the subspecialty of acute care-intensivist neurology have improved the management of severe encephalitis complicated by respiratory compromise, impaired cerebral perfusion, raised ICP, and control of intractable seizures. Maintenance of vital functions and preservation of neural function are clear goals in the patient with encephalitis.

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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Figures

Image of FIGURE 3.1
FIGURE 3.1

EEG evaluation of impaired consciousness in a 61-year-old man with alteration of mental status following cerebrovascular accident. EEG tracings from right hemisphere demonstrate rhythmic spike and slow wave activity with non-convulsive status epilepticus. (Courtesy of Huned Patwa, Yale University School of Medicine.)

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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References

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Tables

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TABLE 3.1

Management issues common to many types of encephalitis

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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TABLE 3.2

Brain stem functions to be evaluated in coma (McNealy and Plum, 1962)

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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TABLE 3.3

GCS scores from each of the three areas are summed for an overall GCS score (Jennett et al., 1977)

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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TABLE 3.4

Management decisions in acute encephalitis

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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TABLE 3.5

Examples of brain stem compromise in encephalitis

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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TABLE 3.6

Rationale for endotracheal intubation and controlled ventilation in encephalitis

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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TABLE 3.7

Fluid and electrolyte issues in encephalitis

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3
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APPENDIX

Encephalitis treatment checklist arranged by clinical classification

Citation: Booss J, Esiri M. 2003. 3 Management Decisions in Acute Encephalitis, p 31-38. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch3

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