What are the symptoms of encephalitis?

Written by Zhang Hui
Neurology
Updated on September 16, 2024
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The clinical manifestations of encephalitis are complex and varied, primarily caused by infections from pathogens such as viruses and bacteria. There are numerous clinical symptoms, with fever being quite common; patients generally exhibit significant fevers, which can reach up to 38 degrees Celsius or even as high as 40 degrees Celsius. Headache is also a very common clinical manifestation of encephalitis, with some patients experiencing severe headaches accompanied by pronounced nausea and vomiting. Additionally, some patients may exhibit psychiatric symptoms, which mainly include incoherent speech, hallucinations, and failing to recognize family members. Some patients may experience cognitive impairments, such as diminished memory, and significant deficits in computational and judgment abilities. In severe cases, some patients may have epileptic seizures, characterized by convulsions of the limbs. Overall, the manifestations of encephalitis are diverse and can range from simple fever and headache to severe conditions such as psychiatric symptoms, cognitive impairments, and epilepsy.

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Neurology
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What is checked for encephalitis?

The examination items for encephalitis mainly include, first, some basic hematological tests. These include routine blood tests, liver and kidney function tests, electrolytes, etc., to understand the status of the patient's white blood cells and whether there is any damage to liver and kidney functions. It is also necessary to test for cardiac enzymes, as some viruses can also affect the heart. Second, an EEG is required. Abnormal EEG patterns, such as increased diffuseness, can be observed in encephalitis, which is important for accurate diagnosis. Third, further examinations like lumbar puncture and cerebrospinal fluid tests are needed. The main focus in cerebrospinal fluid is to see if there is an increase in white blood cells and to check if there are any changes in protein and sugar levels in the fluid. This has great reference value for diagnosing whether it is encephalitis and what type of encephalitis it might be. Fourth, a cranial MRI can be performed to clearly identify if there are any organic lesions in the brain.

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After-effects of encephalitis

Some more serious types of encephalitis may leave sequelae. For example, common ones like herpes simplex viral encephalitis and epidemic encephalitis B. A minority of patients may suffer from certain degrees of sequelae, which typically include the following aspects. Firstly, some patients may experience secondary epileptic seizures, which present with loss of consciousness, limb convulsions, incontinence, and frothing at the mouth. These symptoms might require long-term oral medication for epilepsy. Secondly, another consequence of encephalitis is cognitive impairment in patients, characterized by significant reductions in computational ability, memory, and executive function. Additionally, some forms of encephalitis might leave patients with psychiatric symptoms, such as speaking incoherently.

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Written by Tang Li Li
Neurology
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How is encephalitis diagnosed?

The diagnosis of encephalitis relies on the following aspects. First, it is based on clinical manifestations. If the patient clearly exhibits symptoms such as headache, fever, nausea, vomiting, and signs of increased intracranial pressure, and physical examination shows positive signs of meningeal irritation, then there is a high suspicion of encephalitis. Second, various auxiliary tests can be conducted. Initially non-invasive tests such as electroencephalograms (EEG) and magnetic resonance imaging (MRI) of the skull can be completed. If the MRI reveals significant abnormalities, such as abnormal signals in the frontal and temporal lobes including the hippocampus, then viral encephalitis should be highly suspected. If the EEG shows moderate abnormalities or increased slow waves, it also indicates damage to the cerebral cortex, serving as an indirect indicator of encephalitis. Third, a lumbar puncture can be performed to ascertain any abnormalities in the cerebrospinal fluid (CSF) routine and biochemical tests. If the cell count is elevated beyond ten times the normal value, an inflammatory infection is considered. There is often a minor to moderate increase in protein. The levels of glucose and chloride may decrease in bacterial and tuberculous encephalitis, while they are generally normal in viral encephalitis.

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Written by Tang Li Li
Neurology
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Is the blood count high in encephalitis?

Not all cases of encephalitis show an increase in blood counts. Elevated blood counts in encephalitis generally occur in bacterial infections, such as the most common pyogenic meningitis. This can cause a significant increase in blood counts, predominantly with neutrophils. Tuberculous meningitis can also show elevated blood counts, but not as prominently as pyogenic meningitis. In cases of viral infection, such as the common herpes simplex virus infection, patients might experience a decrease in blood counts. This is characterized by a reduction in the total number of white blood cells, a lower proportion of neutrophils, and a possible increase in lymphocyte proportion. If the patient has a concurrent lung infection or other bacterial infections at different sites, there might be an increase in blood counts, which can mask the blood abnormalities originally caused by the viral infection.

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Viral encephalitis and bacterial encephalitis differences

There are significant differences between viral encephalitis and bacterial encephalitis in clinical settings. Firstly, their clinical symptoms differ; the fever in viral encephalitis is generally lower than that in bacterial encephalitis, where there may be widespread chills and persistent high fever. From another perspective, laboratory tests also help differentiate the two. In viral encephalitis, a routine blood test shows no increase in white blood cells, mainly an increase in the proportion of lymphocytes. In contrast, bacterial encephalitis is characterized by a significant increase in white blood cells, which aids in distinguishing the two. Furthermore, an essential diagnostic tool is the lumbar puncture, through which cerebrospinal fluid can be tested. In viral encephalitis, the white blood cell count in the cerebrospinal fluid is slightly increased; in bacterial encephalitis, it is significantly increased. The cerebrospinal fluid in viral encephalitis has a slight increase in protein content with no significant change in chloride levels; however, in bacterial encephalitis, the protein content in the cerebrospinal fluid is notably higher, and there is a significant decrease in chloride levels.