This document provides an overview of acute viral encephalitis. It defines encephalitis and meningoencephalitis, and discusses the causes, pathogenesis, clinical manifestations, diagnosis and management of viral encephalitis. The most common causes are viruses like herpes simplex virus, varicella zoster virus, enteroviruses, and arboviruses. Diagnosis involves CSF analysis, imaging, and PCR. Management involves supportive care, antiviral drugs like acyclovir, and controlling raised intracranial pressure. Prognosis depends on factors like age, severity of symptoms, and time to treatment initiation. Rehabilitation is often needed due to potential neurological sequelae. Early diagnosis and treatment are emphasized to
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called ORIENTIA TSUTSUGAMUSHI.
Scrub typhus is spread to people through bites of infected chiggers (larval mites).
Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to areas where scrub typhus is found could get infected
Scrub typhus is not transmitted directly from person to person; it is only transmitted by the bites of vectors
Chiggers are abundant in locales with high relative humidity (60%–85%), low temperature (20°C–30°C), low incidence of sunlight, and a dense substrate-vegetative canopy.
Occupational risk is higher in farmers (aged 50–69 years), females.
This presentation briefly summarizes pathophysiology, clinical features, diagnosis and treatment of different types of tuberculosis of brain and spinal cord.
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called ORIENTIA TSUTSUGAMUSHI.
Scrub typhus is spread to people through bites of infected chiggers (larval mites).
Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to areas where scrub typhus is found could get infected
Scrub typhus is not transmitted directly from person to person; it is only transmitted by the bites of vectors
Chiggers are abundant in locales with high relative humidity (60%–85%), low temperature (20°C–30°C), low incidence of sunlight, and a dense substrate-vegetative canopy.
Occupational risk is higher in farmers (aged 50–69 years), females.
This presentation briefly summarizes pathophysiology, clinical features, diagnosis and treatment of different types of tuberculosis of brain and spinal cord.
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Introduction
Encephalitis is defined as an inflammation of the brain caused either
by infection, usually with a virus, or from a primary autoimmune
process .
Many patients with encephalitis also have evidence of associated
meningitis (meningoencephalitis) and, in some cases, involvement of
the spinal cord or nerve roots (encephalomyelitis,
encephalomyeloradiculitis)
3. Definitions
Meningoencephalitis - is an acute inflammatory process involving
the meninges and to a variable degree, brain tissue. Is a common
term that recognizes the overlap
Encephalopathy - describes a clinical syndrome of altered mental
status, manifesting as reduced consciousness or altered behaviour.
9. Viral encephalitis
WHO Clinical case definition of acute encephalitis syndrome
• Person of any age, at any time of year, with
• Acute onset of fever AND
• Change in mental status (including symptoms such as confusion,
disorientation, coma, or inability to talk)AND/OR
• New onset of seizures (excluding simple febrile seizures)
• Other early clinical findings can include an increase in irritability,
somnolence or abnormal behaviour greater than that seen with usual
febrile illness
10. herpes simplex virus type 1 (HSV1) is reportedly the commonest
cause of adult sporadic encephalitis while varicella zoster virus (VZV)
account for most of paediatric encephalitis
Recent studies have identified many emerging encephalitic viruses
such as Chandipura and Nipah viruses particularly in South Asia
11.
12.
13. Scenario in Nepal
Although Japanese encephalitis virus (JEV) was thought to be a
major cause for acute encephalitis syndrome, more non-Japanese
encephalitis virus cases are reported.
N 52 –
Encephalitis 9
JE -33%
HSV 1- 22.2%
cause not known – 44.8%(4)
19. Specific sites of viral predilection
Temporal and inferior frontal lobes (HSV)
Periventricular areas (CMV)
Limbic system (RV)
Cerebellum (VZV)
Basal ganglia (JEV)
20. Clinical manifestations
Fever
Headache
Lethargy
Vomiting
Impairment of consciousness (confusion, behavioral abnormalities,
lethargy to coma )
Focal neurological signs aphasia, ataxia, upper or lower motor neuron
patterns of weakness, involuntary movements (e.g., myoclonic jerks,
tremor), and cranial nerve deficits (e.g., ocular palsies, facial weakness).
Seizures.
21. may have hallucinations, agitation, personality change, behavioral
disorders, and, at times, a frankly psychotic state.
Involvement of the hypothalamic-pituitary axis may result in
temperature dysregulation, diabetes insipidus, or the development
of SIADH
22. occasionally accompanied by photophobia and a stiff neck.
Physical examination characteristically reveals signs of nuchal
rigidity, but its absence does not rule out the diagnosis.
23. Clinical clues
Encephalitis associated with GIT symptoms
-Enteroviruses,
-Rotavirus,
- Parechovirus.
Encephalitis associated with respiratory illness
-Influenza viruses: Myositis may also be associated.
-Paramyxoviruses,
- Bacteria.
27. CSF examination
CSF pleocytosis ( >5 cells/μL) - 95% patients
rare cases, a pleocytosis may be absent on the initia lumbar
puncture (LP) but present on subsequent LPs.
Mildly elevated protein
Normal glucose concentration
CSF pressure normal or slightly raised
28. Arboviruses (e.g., EEE virus or California encephalitis virus), mumps,
and lymphocytic choriomeningitis virus (LCMV) may occasionally
cell counts >1000/μL
Atypical lymphocytes -EBV , CMV, HSV
plasmacytoid or Mollaret-like large mononuclear cells –WNV
About 20% of patients with encephalitis will have a significant
number of red blood cells (>500/μL) in the CSF in a nontraumatic tap.
hemorrhagic encephalitis of the type seen with HSV
29. CSF PCR
primary diagnostic test for CNS infections caused by CMV, EBV, HHV-6,
and enteroviruses.
sensitivity (~96%) and specificity (~99%) of HSV CSF PCR
negative HSV CSF PCR tests that were obtained early (≤72 h) following
symptom onset and that became positive when repeated 1–3 days
later.
PCR results are generally not affected by ≤1 week of antiviral therapy
30. CSF culture is generally of limited utility in the diagnosis of acute
viral encephalitis.
Serum antibody determination is less useful for viruses with high
seroprevalence rates in the general population such as HSV,VZV,
CMV, and EBV
antibodies to HSV-1 glycoproteins and HSV glycoprotein antigens
have been detected in the CSF. Optimal detection of both HSV
antibodies and antigen typically occurs after the first week of illness,
limiting the utility of these tests in acute diagnosis.
Useful in detecting illness is >1 week in duration and who are CSF
PCR–negative for HSV .
31. EEG
EEG is strongly recommended in any suspected case of acute
encephalitis since it may help in distinguishing focal encephalitis
from generalised encephalopathy.
non-specific (slowing) with more characteristic changes (2–3 Hz
periodic lateralised epileptiform discharges originating from the
temporal lobes) limited to about half the cases in the later stages
32. Imaging
CT
subtle low density within the anterior and medial parts of the
temporal lobe and the island of Reil (insular cortex)
MRI
33. Temporal lobe involvement is strongly suggestive of herpes simplex
virus (HSV) encephalitis, although other herpes viruses (eg,VZV,
Epstein-Barr virus, human herpesvirus 6)
areas of increased signal intensity in the frontotemporal, cingulate,
or insular regions of the brain on T2 ,(FLAIR), or dwi MRI common in
HSV encephalitis.
thalamus or basal ganglia may be observed in the setting of
encephalitis due to respiratory viral infection, Creutzfeld-Jacob
disease, arbovirus, and tuberculosis
38. Management
Emergent issues
-ABC of resuscitation
-Consider admission to ICU
-Fluid restriction
-Avoidance of hypotonic intravenous solutions
-Suppression of fever
-Management of raised ICP
39. Acyclovir is of benefit in the treatment of HSV and should be
started empirically in patients with suspected viral encephalitis .
deoxypyrimidine (thymidine) kinase
acyclovir acyclovir-5′-monophosphate
inhibiting viral DNA polymerase and by causing premature
termination of nascent viral DNA chains
40. IV Acyclovir 10mg/kg every 8 hrly ( 30mg/kg total daily dose)
* 21 days
acyclovir should be diluted to a concentration ≤7 mg/mL , Each dose
should be infused slowly over 1 h minimize the risk of renal
dysfunction .
Oral antiviral drugs with efficacy against HSV,VZV, and EBV,
including acyclovir, famciclovir, and valacyclovir, have not been
evaluated
41. IV Dexamethasone (10 mg every 6 h intravenously for 4 days) is
efficacious .
Ganciclovir and foscarnet, either alone or in combination, are
often used in the treatment of CMV-related CNS infection.
-Induction Ganciclovir 5 mg/kg every 12 h given IV over 1 h. -
maintenance therapy of 5 mg/kg every day for an indefinite period
-induction Foscarnet 60 mg/kg every 8 h administered by constant
infusion over 1 h. For 14-21 days
maintenance therapy (60–120 mg/kg per day) cont.
42. Intravenous ribavirin (15–25 mg/kg per day in divided doses given every
8 h) California encephalitis (LaCrosse) virus.
No specific antiviral therapy of proven efficacy is currently available for
treatment of WNV encephalitis
Patients have been treated with interferon-α, ribavirin, an Israeli IVIg
preparation that contains high-titer anti-WNV antibody (Omr-IgG-am)
43. Seizures should be treated with standard anticonvulsant regimens,
and prophylactic therapy should be considered in view of the high
frequency of seizures in severe cases of encephalitis
44. Features of raised ICP
Asymmetric pupil,
Tonic posturing,
Papilloedema
Managemant
- Proper positioning: Head elevated 15-300.
-Fluid Restriction: 2/3rd of maintenance.
• 20% Mannitol 5 ml/kg over 10 – 15 min followed by 3
ml/kg every 6 hourly for 48 hrs then SOS, or
-Acetazolamide: 50 – 75 mg/kg/day, or
-Glycerin: 1 ml/kg/day through NGTube
45.
46.
47. Japanese encephalitis
JEV is the most important cause of viral encephalitis in Asia.
Primarily affects children under age 15 .
Most JEV infections are mild (fever and headache) or without
apparent symptoms
transmitted to humans through bites from infected mosquitoes of
the Culex species
WHO recommends testing for JEV-specific IgM antibody in a single
sample of cerebrospinal fluid (CSF)
There is no antiviral treatment for patients with JE
48. Nipah virus encephalitis
first recognised among pig farmers in Malaysia between 1998 and 1999
paramyxovirus (named Nipah virus)
human illness was characterised by a history of direct contact with pigs
in the livestock farm.
short incubation period (two weeks), rapidly declining level of
consciousness, prominent brain stem dysfunction, and high fatality
rates.
segmental myoclonus, areflexia, hypotonia, and dysautonomia
Supportive care is the mainstay of treatment
49. Sequele
Behavioural and psychiatric disturbances
Epilepsy
Post-encephalitic parkinsonism
Memory difficulties
Speech disturbances
Permanent home care
50. Prognosis
Factors of bad prognosis
• Severe neurologic impairment
• Older age
• High viral load in CSF
• Delay in initiation of therapy
52. Take home message
-Acute viral encephalitis is frequently devastating-
-All patients with a febrile illness and altered behaviour or
consciousness should be investigated promptly for viral
encephalitis
-Patients suspected need a lumbar puncture as soon as
possible
-Early institution of therapy improves prognosis