Post Encephalitic Syndrome

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post encephalitic syndrome, encephalititis lethargica

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Post Encephalitic Syndrome

  1. 1. “ Post encephalitic psychiatric sequelae” Clinical LaisonPsychiatry, 11/09/2010
  2. 2. <ul><li>Encephalitis refers to an inflammation of the brain tissues. </li></ul><ul><li>It can involve different regions of the brain and can be caused by different etiological agents. Whether directly or through immunological reaction not clear. ( more of viral cause in this context) </li></ul><ul><li>In many cases it is followed by complete remission, but can also infrequently result in transient or persisting post encephalitis sequalae. </li></ul><ul><li>These sequalae can manifest as a wide variety of clinical presentations, which pose challenges to clinicians in the realms of diagnosis and management. </li></ul>
  3. 3. <ul><li>3.5 to 7.4 per 100,000 patient years. </li></ul><ul><li>HSV most common sporadic cause in western world. </li></ul><ul><li>Epidemic of viral encephalitis is increasing. (HIV) </li></ul><ul><li>Clinical presentation. </li></ul><ul><li>Encephatitis lethargica. </li></ul>
  4. 4. ICD –F 07 <ul><li>Personality and behavioural disorders due to brain disease, damage and disfunction. </li></ul><ul><li>F 07.0 organic personality disorder </li></ul><ul><li>F 07.1 post encephalitic syndrome </li></ul><ul><li>F 07.2 post concussional syndrome. </li></ul><ul><li>F07.8 other </li></ul><ul><li>F07.9 unspecified </li></ul>
  5. 5. POSTENCEPHALITIC SYNDROME ( ICD) <ul><li>A syndrome which includes residual behavioral change that follows recovery from viral or bacterial encephalitis. </li></ul><ul><li>The symptoms are nonspecific and depend on the individual, the infectious agent, and the age of the individual at the time of the infection. </li></ul><ul><li>The disorder is often reversible , in contrast to the organic personality disorders. </li></ul><ul><li>The symptoms of the disorder include general malaise, apathy or irritability, learning difficulties, altered sleep and eating patterns, and changes in sexuality and in social judgment. </li></ul><ul><li>There may be a variety of residual neurological dysfunctions such as paralysis, deafness, aphasia, constructional apraxia and acalculia. </li></ul>
  6. 6. <ul><li>JE associated with psychiatric presentations like social inappropriteness, aggression , emotional lability, affective and paranoid symptoms ( monnet 2003) </li></ul><ul><li>HSV , EBV acute presentations with psychiatric syndromes. </li></ul><ul><li>Fatigue syndrome after 6 months of glandular fever. </li></ul><ul><li>Kluver-Bucy syndrome after herpes encephalitis, tick-borne encephalitis lead to fatigue, memory problems </li></ul><ul><li>Mood changes at recovery. </li></ul><ul><li>Influenza epidemic, sydenhams chorea SSPE, PANDAS </li></ul>
  7. 7. Encephalitis lethargica <ul><li>Von Economo. 1917 </li></ul><ul><li>Influenza like prodrome with variety of nervous manifestations like distuburbed sleep, lethargy, disturbance of ocular movements. </li></ul><ul><li>Psychiatric symptoms + </li></ul><ul><li>Post encephalitic psychosis depression, hypomania, catatonic symptoms, ocd mutism. </li></ul>
  8. 8. Present day Encephalitis lethargica <ul><li>Sporadic cases. </li></ul><ul><li>Dale et al 2004 report 20 cases with classic neuropsychiatric manifestations. </li></ul><ul><li>Immune mediated like in PANDAS. </li></ul><ul><li>Clinical relevance is to keep a high index of suspicion and psychiatric symptoms may be the predominant manifestation. </li></ul><ul><li>Whether catatonia related to encephalitic processes? </li></ul>

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