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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How is encephalitis transmitted?

The commonly mentioned encephalitis is mainly caused by viral infections. There are many types of viruses that can cause encephalitis, including the more severe herpes simplex virus, varicella-zoster virus, etc. There are also some enteroviruses, like Coxsackie virus, and some adenoviruses. Typically, the transmission of encephalitis can occur via the fecal-oral route, where some enteroviruses enter the digestive tract through this route, then from the cells of the digestive tract to the bloodstream, and from there to the brain. Additionally, some viruses are transmitted through blood contact. For instance, if a patient has blisters that rupture and release a large amount of virus, and another person's blood comes into contact with these fluids, transmission can occur via blood. Generally, encephalitis is primarily transmitted through fecal-oral routes and bloodborne transmission.

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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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Written by Zhang Hui
Neurology
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How to check for encephalitis?

To check for encephalitis, the main aspects of examination include the following. First, a complete blood count is necessary, which helps to determine if there is an increase in white blood cells and to assess the proportion of various types of white blood cells; this is a basic test. The second examination is an electroencephalogram (EEG), if the EEG shows abnormalities, it may suggest a diagnosis of encephalitis. The third examination involves cranial magnetic resonance imaging (MRI). If the encephalitis is severe, the MRI can reveal lesions, which also suggests a diagnosis of encephalitis. The fourth examination is invasive, involving a lumbar puncture. This test allows for the analysis of cerebrospinal fluid, assessing whether there is an increase in white blood cells and proteins in the fluid, which plays an important role in the diagnosis of encephalitis. In summary, diagnosing encephalitis necessitates a complete blood count, cranial MRI, analysis of cerebrospinal fluid, and a comprehensive EEG examination.

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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.

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Can encephalitis be cured?

Encephalitis is divided into many types. If it is a simple herpes virus encephalitis infection, this is a rather dangerous type of encephalitis. Before the advent of antiviral drugs, the mortality rate of this type of encephalitis was very high. Now, with improvements in diagnostic and treatment levels and the development of antiviral drugs, the prognosis for this type of encephalitis is generally quite good. As long as the initial condition is not particularly severe, the patient is not in a coma, or there is no obvious continuous epileptic state, the prognosis is still good, and many patients do not have any residual sequelae. However, if the initial condition is quite severe, there is usually some degree of cognitive impairment or weakness in the limbs. Other viral encephalitides, such as those caused by Coxsackie viruses and adenoviruses, tend to have milder symptoms, mainly fever, headache, nausea, and vomiting. These types of encephalitis can mostly be cured with appropriate symptomatic treatment and antiviral therapy.