Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • fever
  • rash
  • parotitis
  • lymphadenopathy
  • optic neuritis
  • altered mental state
  • focal neurologic deficit
  • meningismus
  • acute flaccid paralysis
  • movement disorder

Other diagnostic factors

  • cough
  • gastrointestinal infection
  • seizures
  • biphasic illness
  • autonomic and hypothalamic disturbances
  • myocarditis/pericarditis
  • jaundice
  • arthritis
  • retinitis
  • parkinsonism

Risk factors

  • age <1 or >65 years
  • immunodeficiency
  • vaccination
  • exposure to infected contacts
  • viral infections
  • blood/body fluid exposure
  • organ transplantation
  • animal or insect bites
  • location
  • season
  • occupation
  • hunting/trekking in woods
  • swimming or diving in warm freshwater or nasal/sinus irrigation
  • spelunking (cave-exploring)
  • death in animals
  • cancer

Diagnostic investigations

1st investigations to order

  • CBC
  • peripheral blood smear
  • serum electrolytes
  • liver function tests
  • blood cultures
  • throat swab
  • nasopharyngeal aspirate
  • sputum culture
  • chest radiography
  • CT brain
  • MRI brain
  • EEG
  • CSF analysis
  • CSF culture
  • CSF serology
  • CSF PCR
Full details

Investigations to consider

  • urine culture
  • stool enteroviral culture
  • IgG and IgM antibodies (blood)
  • PCR (blood)
  • HIV serology/RNA test
  • CSF biomarkers/prion protein assay
  • paraneoplastic antibodies (blood and CSF)
  • whole-body CT
  • whole-body PET scans
  • magnetic resonance spectroscopy
  • next-generation sequencing of CSF
  • brain biopsy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Assistant Professor

Department of Neurology

University of Washington Medical Centre

Seattle

WA

Disclosures

LHW declares that he has no competing interests.

Clinical Pharmacist

Southern California Hospital

Culver City

CA

Disclosures

LTW declares that she has no competing interests.

Professor, Pathology and Immunology

Head, Division of Neuropathology

Washington University School of Medicine

St. Louis

MO

Disclosures

RS declares that he has no competing interests.

Assistant Professor

Department of Neurology

University of Washington

Seattle

WA

Disclosures

KDR declares that she has no competing interests.

Dr Leo H. Wang, Dr Louise T. Wang, Dr Robert Schmidt, and Dr Kimiko Domoto-Reilly would like to gratefully acknowledge Dr Catalina C. Ionita, Dr Manjunath Markandaya, and Dr David Janicke, previous contributors to this monograph. CCI, MM, and DJ declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Paediatric Neurology

The University of Sydney

Consultant Neurologist

The Children's Hospital at Westmead

Sydney

Australia

Disclosures

RD declares that he has no competing interests.

Associate Professor, Neurology

Director

Johns Hopkins Encephalitis Center

Johns Hopkins Hospital

Baltimore

MD

Disclosures

AV declares that he has no competing interests.

Use of this content is subject to our disclaimer