How is encephalitis diagnosed?

Written by Zhang Hui
Neurology
Updated on September 02, 2024
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The diagnosis of encephalitis cannot rely solely on auxiliary examinations; it must depend on the patient's medical history, clinical manifestations, and corresponding physical examination. If a patient presents with fever, headache, nausea, vomiting, and signs of nuchal rigidity upon examination, the possibility of encephalitis should be considered. Additionally, severe cases of encephalitis may exhibit seizures, cognitive changes, and personality alterations. Auxiliary examinations mainly include three types: the first type is imaging studies, primarily brain MRI, which can clearly identify the specific areas of the brain affected and determine which brain lobe is damaged. The second important examination is an electroencephalogram (EEG), which can detect diffuse slow waves, especially a significant presence of delta waves, highly indicative of encephalitis. The third important auxiliary examination is lumbar puncture for cerebrospinal fluid analysis; an increase in white blood cells and protein in the cerebrospinal fluid also suggests inflammation within the skull. Therefore, the main auxiliary examinations for encephalitis include MRI, EEG, and lumbar puncture.

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Written by Zhang Hui
Neurology
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Does encephalitis cause a runny nose?

Encephalitis can potentially cause a runny nose, as it is mainly caused by viral infections. These infections not only invade brain cells, leading to symptoms such as fever, headache, nausea, vomiting, and even seizures related to the nervous system, but can also affect the respiratory tract. If these viruses accumulate in the respiratory tract, particularly in the nasal mucosa, they will definitely cause symptoms such as a runny nose, cough, expectoration, and sore throat. Therefore, it is evident that patients with encephalitis can exhibit symptoms of upper respiratory tract infections. Moreover, some patients initially present with respiratory symptoms, such as a runny nose, before the viruses enter and infect the brain cells. Patients with encephalitis must receive timely treatment, primarily symptomatic treatment to prevent complications, along with antiviral medication for targeted treatment. Most patients have a good prognosis.

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Written by Tang Li Li
Neurology
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How is encephalitis caused?

Encephalitis generally falls into two categories: one is infectious inflammation caused by pathogenic infections, and the other is immune inflammation caused by abnormalities in immune mechanisms. Among these, the infectious type is the most common, including viral encephalitis, viral meningitis, tuberculous meningoencephalitis, purulent meningitis, and cryptococcal meningitis, which are associated with infections by viruses, bacteria, Mycobacterium tuberculosis, and Cryptococcus, respectively. Additionally, abnormalities in the immune system often cause autoimmune encephalitis, as well as multiple sclerosis and neuromyelitis optica when involving the brain, and acute disseminated encephalomyelitis, all of which are types of autoimmune encephalitis. The treatment approaches for these two types of encephalitis are different. For pathogen-induced cases, treatment primarily targets the pathogens: antiviral drugs for viral encephalitis, antibiotics for bacterial encephalitis, anti-tubercular therapy involving multiple drugs for Mycobacterium tuberculosis infection, and antifungal drugs, such as amphotericin B, for cryptococcal meningitis. For immune-mediated encephalitis, treatments generally involve immunosuppressants, high-dose corticosteroids, or intravenous immunoglobulins.

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Written by Zhang Hui
Neurology
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How is encephalitis caused?

Encephalitis generally occurs when pathogens invade the central nervous system of the brain, resulting in corresponding clinical manifestations. Patients may exhibit symptoms such as headache, fever, nausea, vomiting, and even paralysis of limbs and cognitive impairments. Patients become confused, with reduced computational and comprehension abilities. Some may also exhibit psychiatric symptoms and even experience seizures and other manifestations of epilepsy. Encephalitis is caused by pathogens, commonly viruses. Viral infections that lead to what is known as viral encephalitis can spread through the bloodstream to the brain and cause illness. Additionally, bacterial infections can also cause encephalitis. There are mainly two routes for bacterial infections: one is through bloodstream transmission leading to inflammation of the nervous system, and the other can occur directly, for example, from inflammation of the mastoids, tonsils, or cavernous sinus, where bacteria directly invade the brain, leading to the respective clinical manifestations. Furthermore, tuberculosis can also infect and cause tuberculous encephalitis, meningitis, and similar conditions.

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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 Zhang Hui
Neurology
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Can encephalitis be cured?

The viruses that cause encephalitis are relatively common. Whether they can be cured depends mainly on the type of virus causing the encephalitis, the severity of the condition, and whether the treatment is timely. Generally, most cases of encephalitis, such as those caused by enterovirus infections, tend to self-heal to a certain extent. The focus should be on care to prevent complications, electrolyte disorders, overheating, and to provide appropriate antiviral treatment. Most patients can be cured. However, there are also some more dangerous types of encephalitis, such as encephalitis caused by the type B encephalitis virus, which can rapidly lead to disturbances in consciousness, seizures, and even respiratory involvement, resulting in respiratory failure. This type of encephalitis is more severe and can leave significant sequelae even if successfully treated. For herpes simplex virus encephalitis, as long as the initial symptoms are not particularly severe and antiviral medications are used in a timely manner, the prognosis is still good.