Encephalitis

Cause Encephalitis is an inflammation of the brain. Acute infectious encephalitis is most often caused by a virus. Enteroviruses cause about 80 percent of all cases. Arboviruses, transmitted by insects such as ticks and mosquitoes, can also cause encephalitis. West Nile encephalitis virus is an example. Measles, mumps, chicken pox, and mononucleosis can sometimes cause encephalitis, usually a mild case. Rabies can also cause encephalitis. Although rare, herpes simplex virus, the virus that causes cold sores, can cause a serious, life-threatening form of encephalitis. Tuberculosis, syphilis, and Lyme disease can also cause brain inflammation.

Symptoms In mild cases, the child may have a fever, headache, poor appetite, lethargy, sensitivity of the eyes to light, and a general "sick" feeling. Severe cases may involve high fever, severe headache, nausea and vomiting, stiff neck, seizures (convulsions), blurred vision, confusion, personality changes, problems in speech or hearing, hallucinations, difficulty moving limbs, involuntary movements, difficulty walking, loss of sensation in some part of the body, memory loss, drowsiness, and coma. In infants, look for vomiting, a full or bulging soft spot (fontanel), and persistent crying and irritability.

How It Spreads Depending on the type, a virus can be spread through airborne nose or throat fluid droplets or through direct contact with an infected person. Encephalitis caused by an arbovirus is not contagious from person to person but must be transmitted by the bite of an infected insect. Rabies is transmitted by a bite or scratch from an infected animal.

Incubation Period The incubation period depends on the cause. Enteroviruses have an incubation of four to six days.

How Long Symptoms Last For most types, the acute phase lasts several days to a week; recovery takes two to three weeks. In severe cases, such as those caused by herpes simplex encephalitis, the child must be hospitalized, and recovery may take several weeks or longer.

When to Call Your Child's Doctor Call your child's doctor immediately if your child has any of the symptoms described earlier, especially if your child is recovering from measles, mumps, or chicken pox and develops a high fever.

How the Diagnosis Is Made Your child's doctor may order blood tests and perform a spinal tap (lumbar puncture) to examine spinal fluid for evidence of infection. An EEG (electroencephalogram), which measures brain waves, and either an MRI or CT scan, which looks for swelling and other changes in the brain, may also be done.

Treatment In some mild cases, children can be treated at home, but others need to be treated and observed closely in a hospital. In most cases children with viral encephalitis will be given nonaspirin medicines to reduce fever and headache and will be placed in a darkened room away from noise and lights to enable comfort and rest. Those with herpes simplex encephalitis will be treated with an antiviral drug like acyclovir. Encephalitis caused by bacteria is treated with appropriate antibiotics.

Prevention Encephalitis caused by common childhood illnesses such as measles, mumps, and chicken pox can be prevented by getting the appropriate vaccinations. In areas with large numbers of mosquitoes during the summer months, keep children indoors from dusk to dawn when mosquitoes feed.

Dress your child in light clothing that covers the skin. If you have stagnant water around, get rid of it because it breeds mosquitoes. To prevent children from being bitten by a tick, make sure they wear long-sleeved shirts and long pants when walking through the woods. Tuck pants into socks. Regularly check for ticks on your child's body after the child has been outside. Make sure your pets are vaccinated for rabies.

Contagious Periods The contagious period varies according to the specific virus.

Complications Most children recover fully from viral encephalitis, but the outcome depends on the severity of the illness and the germ involved. Severe cases of encephalitis can cause damage to the nervous system that can result in epilepsy, hearing and visual problems, and impairment of intelligence and movement. Herpes simplex encephalitis is often fatal.

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