eMedicine Specialties > Emergency Medicine > Neurology

Encephalitis: Follow-up

Author: Marjorie Lazoff, MD, Editor-in-Chief, Medical Computing Review
Contributor Information and Disclosures

Updated: Jul 16, 2009

Follow-up

Further Inpatient Care

  • Admit the patient to a unit or floor, as appropriate.
  • The admitting physician should arrange for EEG, brain biopsy (for HSE), and other advanced measures as indicated.

Deterrence/Prevention

  • During summer and fall months, emergency physicians should not hesitate to obtain viral cultures to check for outbreaks of arboviral infection. Public health measures, such as insecticide spraying, may be necessary.
  • Immunization against JE is recommended for those traveling into endemic areas during high-risk times of year.

Complications

  • Seizures
  • Syndrome of inappropriate secretion of antidiuretic hormone
  • Increased ICP
  • Coma

Prognosis

  • The prognosis depends the virulence of the virus and on variables associated with the patient's health status, such as extremes of age, immune status, and preexisting neurologic conditions.
    • Rabies, EEE, JE, and untreated HSE have high rates of mortality and severe morbidity, including mental retardation, hemiplegia, and seizures.
    • Increased mortality and morbidity rates are found in patients who are older than 60 years and have St Louis encephalitis or WNE. Long-term sequelae with St Louis encephalitis include behavioral disorders, memory loss, and seizures.
    • WEE is associated with relatively low mortality and morbidity rates, although developmental delay, seizure disorder, and paralysis occur in children, and postencephalitic parkinsonism occurs in adults.
    • CE usually is a milder disease, with most patients making a full recovery, though 25% of those with severe disease continue to have focal neurologic dysfunction.
    • The mortality rate in treated HSE averages 20% and is correlated with mental status changes at time of first dose of acyclovir. Approximately 40% of survivors have minor-to-major learning disabilities, memory impairment, neuropsychiatric abnormalities, epilepsy, fine-motor-control deficits, and dysarthria.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider HSE in the diagnosis or to initiate administration of acyclovir in a timely fashion
 


More on Encephalitis

Overview: Encephalitis
Differential Diagnoses & Workup: Encephalitis
Treatment & Medication: Encephalitis
Follow-up: Encephalitis
References
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References

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Further Reading

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Keywords

encephalitis, West nile virus, cerebritis, acute encephalitis, herpes simplex encephalitis, HSE, varicella-zoster encephalitis, VZ encephalitis, West Nile encephalitis, St Louis encephalitis, SLE, California virus encephalitis, LaCross encephalitis, eastern equine encephalitis, western equine encephalitis, Powassan virus, Japanese virus encephalitis, JE, arboviral JE, subacute encephalopathies, chronic encephalopathies, acute arboviral encephalitides, acute viral encephalitides, cytomegalovirus encephalitis, CMV encephalitis, sclerosing panencephalitis, progressive multifocal leukoencephalopathy, HSV Cowdry type A inclusions, acute disseminated encephalitis, postinfectious encephalomyelitis, Epstein-Barr virus, EBV encephalitis, subacute sclerosing panencephalitis, rabies encephalitis, acute disseminated encephalitis, stiff neck, photophobia, lethargy, toxoplasma encephalopathy, meningismus

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Contributor Information and Disclosures

Author

Marjorie Lazoff, MD, Editor-in-Chief, Medical Computing Review
Marjorie Lazoff, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Informatics Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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