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Encephalitis

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of encephalitis are prepared by our editorial team based on guidelines from the Association of British Neurologists (ABN/BIA 2012), the Association of British Neurologists (ABN/BPAIIG 2012), and the Infectious Diseases Society of America (IDSA 2008). ...
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Screening and diagnosis

Clinical presentation: as per ABN/BIA 2012 guidelines, suspect encephalitis or another CNS infection in patients with current or recent febrile illness with altered behavior, cognition, personality or consciousness, or new seizures or focal neurological signs.
B
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Diagnostic investigations

Clinical assessment: as per IDSA 2008 guidelines, assess for epidemiologic clues and risk factors to identify potential etiologic agents in patients with encephalitis.
B
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  • Evaluation for infectious etiology

  • Neuroimaging

  • Electroencephalography

Diagnostic procedures

Lumbar puncture: as per ABN/BIA 2012 guidelines, perform lumbar puncture as soon as possible after hospital admission in all patients with suspected encephalitis, unless there is a clinical contraindication.
B
consider performing an immediate lumbar puncture after CT on a case-by-case basis, unless the imaging reveals significant brain shift or tight basal cisterns due to or causing raised ICP or an alternative diagnosis or the patient's clinical condition changes.
B
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  • Brain biopsy

Medical management

Setting of care: as per ABN/BIA 2012 guidelines, obtain immediate neurological specialist consultation in patients with suspected acute encephalitis and manage them in a setting where a clinical neurological review can be obtained as soon as possible and definitely within 24 hours of referral.
B
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  • Empirical therapy

  • Specific therapy (viruses)

  • Specific therapy (bacteria)

  • Specific therapy (mycobacteria)

  • Specific therapy (rickettsiae and ehrlichiae)

  • Specific therapy (spirochetes)

  • Specific therapy (fungi)

  • Specific therapy (protozoa)

  • Specific therapy (helminths)

  • Specific therapy (acute disseminated encephalomyelitis)

Specific circumstances

Patients with autoimmune encephalitis: as per ABN/BIA 2012 guidelines, include antibody-mediated encephalitis in the differential diagnosis of all patients with suspected encephalitis because of the poor outcomes if left untreated.
B
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Follow-up and surveillance

Follow-up
As per ABN/BIA 2012 guidelines:
Do not discharge patients from the hospital without either a definite or suspected diagnosis. Formulate an arrangement for the outpatient follow-up (to include at least one follow-up appointment) and plans for ongoing therapy and rehabilitation at a discharge meeting.
D
Ensure that all patients have access to assessment for rehabilitation, irrespective of age.
B