Summary
Definition
History and exam
Key diagnostic factors
- fever
- rash
- altered mental state
- focal neurologic deficit
- meningismus
- parotitis
- lymphadenopathy
- optic neuritis
- 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
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
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.
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