Encephalitis In Children

Encephalitis is inflammation of brain parenchyma producing encephalopathy with evidence of CNS inflammation. Viral infection is the commonest recognized cause. HSV is particularly important because delayed aciclovir markedly worsens outcome.

Other causes include enteroviruses, arboviruses, VZV and autoimmune encephalitis.

• Fever
• Altered behaviour or consciousness
• Seizures
• Headache
• Focal neurological deficits
• Movement abnormalities
• Memory or personality change

HSV encephalitis often produces focal seizures, behavioural change and temporal lobe features.

• Lumbar puncture for CSF cells, protein, glucose, culture and viral PCR.

• HSV PCR is critical when HSV is possible.

• MRI brain is preferred to CT and may show temporal lobe abnormalities in HSV.

• EEG may demonstrate focal or diffuse encephalopathic changes and can detect non convulsive status.

• Exclude hypoglycaemia, metabolic encephalopathy, meningitis, cerebral malaria and toxic ingestion.

• Start aciclovir 20 mg/kg IV every 8 hours immediately when HSV encephalitis is possible. Continue 14 to 21 days if confirmed, with renal dose adjustment and adequate hydration.

• Treat seizures promptly.

• Maintain oxygenation, cerebral perfusion, glucose and electrolyte balance.

• Manage raised intracranial pressure where present.

• Add empirical antibacterial meningitis treatment until bacterial infection has been reasonably excluded when presentation overlaps.