Lectures

Encephalitis: Supportive Management

by John Fisher, MD
(1)

Questions about the lecture
My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides Encephalitis InfectiousDiseases.pdf
    • PDF
      Download Lecture Overview
    Report mistake
    Transcript

    00:02 So, how do you manage patients with encephalitis? Well, if they are very sick, obviously, they have to be monitored in the intensive care unit.

    00:13 Now, do you have to isolate them? We certainly don't have to isolate them for herpes virus.

    00:19 They're not contagious if they have herpes encephalitis We certainly don't have to isolate them for herpes virus.

    00:19 They're not contagious if they have herpes encephalitis unless they have some sort of active lesion on their mouth, genitalia or some kind of rash consistent.

    00:31 So, generally, you don't have to isolate patients with herpes virus and certainly you don't have to isolate them if it's been caused by a mosquito unless the hospital is rampant with mosquitoes, which is unusual. and certainly you don't have to isolate them if it's been caused by a mosquito unless the hospital is rampant with mosquitoes, which is unusual.

    00:45 But if it's just encephalitis of unknown cause, then respiratory or contact isolation would be prudent.

    00:53 If they have seizures, you’re going to manage those seizures with benzodiazepines acutely, and you would maintain them on fosphenytoin IV.

    01:05 And the certainly increased intracranial pressure can occur and is dangerous, so the neurosurgeons will often put a continuously monitoring lead for increased intracranial pressure.

    01:22 Corticosteroids may also be required; and if it's very severe, hyperventilation and IV mannitol.

    01:34 Lumbar punctures need to be avoided in patients with increased intracranial pressure due to the scare of herniating.

    01:46 As far as empirical therapy goes, sometimes you can't tell what's causing the encephalitis.

    01:53 So, what you’ve got to do is treat everybody as if they had herpes simplex encephalitis and give IV acyclovir.

    02:02 And that's the goal.

    02:04 There's no proven benefit in other forms of encephalitis.

    02:09 Now, if you know the patient also has influenza, if the viral studies indicate influenza, we would give oseltamivir, which is a neuraminidase inhibitor.

    02:20 But looking at the mechanism of action, it doesn't honestly make a lot of sense that it would work well in the central nervous system, and so we need more data on whether it works.

    02:33 Nevertheless, we don't have anything else to do.

    02:36 And the treatment with oseltamivir is relatively benign.

    02:41 So, in somebody with influenza encephalitis, we would give it.

    02:46 Rabies is essentially untreatable, although there are one or two patients who have survived this.

    02:54 And this was accomplished with inducing a coma and giving IV ribavirin.

    03:05 In other words, we essentially induced coma in the patient with proven rabies and gave the patient enteral amantadine.

    03:14 And this was done on a 15-year-old girl.

    03:18 Her survival was reported in The New England Journal of Medicine.

    03:22 So, using that model, we are treating patients with that kind of a model.

    03:30 But there have been patients treated that way that have not survived.

    03:34 And that brings us to the end of our discussion about encephalitis.


    About the Lecture

    The lecture Encephalitis: Supportive Management by John Fisher, MD is from the course CNS Infection—Infectious Diseases. It contains the following chapters:

    • Encephalitis – Supportive Management
    • Viral Encephalitis – Antimicrobial Therapy

    Included Quiz Questions

    1. A patient with encephalitis of unknown cause.
    2. A patient with herpes encephalitis.
    3. A patient with West Nile viral encephalitis.
    4. A patient with Japanese encephalitis.
    5. A patient with California encephalitis.
    1. Corticosteroids
    2. Lumbar puncture to release pressure
    3. Benzodiazepines
    4. Empirical antibiotic treatment
    5. Neurosurgery
    1. Intravenous acyclovir
    2. Oral oseltamivir
    3. Simple fluid resuscitation
    4. Coma induction
    5. Enteral amantidine

    Author of lecture Encephalitis: Supportive Management

     John Fisher, MD

    John Fisher, MD


    Customer reviews

    (1)
    5,0 of 5 stars
    5 Stars
    5
    4 Stars
    0
    3 Stars
    0
    2 Stars
    0
    1  Star
    0