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- Encephalitis, inflammation of the brain, is associated with the following signs and symptoms: fever, headache, altered mental status, neurologic deficit, hallucinations, behavioral changes, photophobia, seizures, neck stiffness (when associated with meningitis), preceding viral prodrome, recent mosquito/tick/animal bites, and/or immunocompromised state/use of immunosuppressant medications.
- The presence of focal neurologic deficit and/or altered mental status is more predictive of encephalitis than meningitis.
- The emergent management goal is to rule out and/or empirically treat bacterial meningitis and other treatable infectious sources such as Herpes Simplex Virus (HSV), Varicella Zoster Virus (VZV), and Cytomegalovirus (CMV); these carry significant mortality and morbidity risks. Remember to have patient's cerebrospinal fluid (CSF) specifically analyzed for etiologies such as these (i.e. via PCR).
- Treat presumed encephalitis aggressively by adding acyclovir to the antibiotic/steroid regimen administered, particularly when there is altered mental status and/or focal neurologic deficit.