This document discusses the treatment and management of encephalitis. The main aims are to maintain vital functions, provide symptomatic management, ensure adequate nutrition, and prevent neurological sequelae. Specific treatments are outlined for different causes of encephalitis, including acyclovir for herpes simplex encephalitis, doxycycline for rickettsia, and amphotericin B or fluconazole for cryptococcal infections. Complications can include personality changes, speech and language problems, memory issues, and epilepsy. The prognosis depends on the cause, with an overall 5% mortality rate and two-thirds of survivors usually recovering fully.

1. TREATMENT
N.NANTHINI
ENCEPHALITIS

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AIMS OFMANAGEMENT
Maintaining vital functions.
Symptomatic management.
Adequate nutrition.
Prevention of neurological sequale.
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MAINTENANCEOFVITALFUNCTIONS
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Airway –
patent
Circulation -
IV fluids ,
vasopressors
Breathing –
assisted
respiration

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BP- dopamine/
dobutamine
Hyperpyrexia-
water-
sponging,
antipyretics
Seizures- IV
diazepam &
phenytoin
ÎÎ ICT –
20% mannitol
&
corticosteroi
ds
SYMPTOMATIC MANAGEMENT

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• Role of Corticosteroids :
acute disseminated encephalomyelitis.
autoimmune encephalitis.
Special conditions where specific drugs are given
HERPES SIMPLEX ENCEPHALITIS :
HSV type 1
: CSF –culture or PCR.
CT – focal involvement of temporal lobe.
TREATMENT: Acyclovir 20mg/kg/dose every 8 hourly for 20 days.
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RICKETTESIA
• Doxycycline -100 mg twice a day for 7 ( if >40 kg)
- 2.2mg/kg twice daily for 7 days
CRYPTOCOCCAL
Amphotericin B – 0.7 to 1 mg /kg/day for 6 to 10 weeks.
(OR)
Amphotericin B + fluconazole -100 mg/ kg/day for 2 weeks.
Followed by fluconazole for minimum 10 weeks.
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Varicella zoster infection:
intravenous acyclovir is the choice of treatment.
Cytomegalovirus infection:
ganciclovir
HIV:
antiretroviral agents.
Mycoplasma pneumoniae:
doxycycline, azithromycin or clarithromycin.
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COMPLICATIONS
• Personality and behavioural changes,
• Speech and language problems,
• Memory problems,
• Swallowing problems,
• Epilepsy,
• Problems with balance and coordination,
• Problems with attention and concentration.
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PROGNOSIS
 overall mortality for infectious encephalitis is 5%.
Among survivors symptoms resolve in 2-3 weeks.
About 23 of patients recover fully ;remainder shows clinically significant residua like
spasticity or paresis, cognitive impairment, weakness , ataxia and recurrent seizures.
Neurological sequelae is common in Japanese encephalitis.
Worse prognosis:
HSV
Eastern equine encephalitis
Mycoplasma pneumoniae
Children < 1yr
Presenting with coma.
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