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La encefalitis es una enfermedad poco comun, se presenta casi siempre en el primer ano de vida, las personas muy jovenes y los ancianos son mas propensos a presentar casos graves. La causa mas frecuente de la encefalitis es una infeccion viral y muchos tipos de virus la pueden provocar. Los diferentes virus capaces de causar encefalitis se presentan en una cierta temporada del ano. La encefalitis ocasionada por el virus del herpes simple es la causa principal de los casos mas severos en todas las edades, incluyendo los recien nacidos. Algunos pacientes con encefalitis pueden tener sintomas de un resfriado o de una infeccion estomacal antes de que los sintomas de encefalitis comiencen. Cuando un caso de encefalitis no es muy severo, los sintomas pueden ser muy similares a los de otras enfermedades, incluyendo: fiebre  que no es muy alta, dolor de cabeza leve, baja energia e inapetencia, torpeza, marcha inestable, confusion, desorientacion, somnolencia, irritabilidad o poco control del temperamento, sensibilidad a la luz, rigidez del cuello y de la espalda (ocasionalmente) y vomito. Los sintomas anteriores pueden hacer creer a la persona que tiene un trastorno psiquiatrico y consultar a un especialista en enfermedades mentales.
El examen fisicode una persona con encefalitis puede mostrar: reflejos anormales, aumento de la presion intracraneal, confusion mental, ulceras bucales, debilidad muscular, rigidez del cuello, signos en otros organos como el higado y los pulmones, erupcion cutanea, problemas del habla. Los objetivos del tratamiento de la encefalitis son brindar al paciente cuidados complementarios (reposo, nutricion, liquidos) para ayudar al cuerpo a combatir la infeccion, y aliviar los sintomas. Medicamentos antivirales, como aciclovir , para tratar la encefalitis por herpes u otras infecciones virales severas (sin embargo, en la mayoria de los casos, no hay medicamentos antivirales especificos disponibles para combatir la infeccion). Esteroides (como la dexametasona) con el fin de reducir el edema cerebral en algunos casos.
Si la funcion cerebral resulta gravemente afectada despues de la encefalitis, se pueden requerir  la fisioterapia o la terapia del lenguaje, despues de que la enfermedad este controlada.
El pronostico varia, algunos casos de encefalitis son leves, cortos y la persona se recupera por completo; mientras que otros casos de encefalitis son graves y pueden ocasionar deterioro permanente o posiblemente la muerte.
La fase aguda de la encefalitis dura normalmente de 1 a 2 semanas, con desaparicion gradual o subita de la fiebre y de los sintomas. El dano cerebral permanente puede ocurrir en casos severos de encefalitis y puede afectar: la audicion, la memoria, el control muscular, la sensibilidad, el lenguaje y la vision. Las vacunas humanas que estan disponibles abarcan: una vacuna para prevenir una forma de encefalitis viral que a menudo afecta a las personas que viven en dormitorios o en el ejercito, Herpes Zoster y Sarampion. Transmission electron micrograph of poliovirus type 1. The CSF shows pleocytosis (early neutrophils, late lymphocytes) and elevated protein, depending on the degree of brain necrosis. Some children with HSV encephalitis develop an encephalopathy characterized by choreoathetosis weeks after CSF becomes negative and Acyclovir treatment is discontinued. Enterovirus (EV) is a small RNA virus transmitted usually from human to human via fecal-oral or respiratory route. Multinucleated giant cells.HIV envelope glycoproteins cause the membranes of HIV-infected macrophages to fuse, forming multinucleated giant cells. Encephalitis causes mental status changes (depressed or altered level of consciousness, lethargy, personality change) associated with fever, seizures, focal neurological deficits, CSF pleocytosis, EEG abnormalities, and variable neuroimaging findings.
The most common autoimmune encephalitis is anti-NMDA receptor encephalitis, which, in some studies, is more frequent than HSV and other viral encephalitides. Anti-NMDA receptor encephalitis is most frequent in young females with ovarian, mediastinal, and other teratomas, but males with testicular and other teratomas and both sexes with other tumors or without evidence of a tumor may be affected.
Another probably immunologically-mediated encephalitis is Rasmussen encephalitis, a rare condition that affects mostly children and young adults.
This course was produced for the use of students, residents, and staff of NEOMED and affiliated hospitals. Magnetic Resonance Imaging (MRI) of the head can be used to detect specific areas of inflammation or bleeding in the brain caused by encephalitis. Encephalitis treatment is performed in the intensive care unit of a hospital where the vital signs of the patient are closely monitored (blood pressure, heart rate, breathing and the body fluids).
Encephalitis caused by arboviruses, which are transmitted by mosquitoes and ticks, do not respond to acyclovir or other medications.

Licence fees: A licence fee will be charged for any media (low or high resolution) used in your project. Este tejido se hincha (edema cerebral), lo cual puede destruir neuronas, provocar sangrado en el cerebro (hemorragia intracerebral) y dano cerebral.
A las personas con estados de confusion o delirio les puede servir la reorientacion y el apoyo emocional.
Algunas personas pueden tardar varios meses para lograr una recuperacion completa despues de la encefalitis. These are eosinophilic masses consisting of packed viral particles and products of their replication.
Viruses that cause inclusions are herpes simplex, cytomegalovirus, varicella-zoster, papovaviruses, and measles.
A few adolescents and adults develop also psychiatric and other manifestations which appear either as a relapse or a continuation of the initial encephalitis. About seventy percent of neonatal HSV infections are caused by HSV-2 (herpes genitalis) and thirty percent by HSV-2. Some patients with this clinical profile have viral encephalitis and a few have infections by other agents, including Bartonella, Chlamydia, Mycoplasma pneumonia, and other. It is characterized clinically by psychiatric features, memory disturbance, speech disorder, seizures, dyskinesias, decreased level of consciousness, autonomic instability, and hypoventilation. These tumors contain neural elements not previously encountered by the immune system and exposed to it because there is no blood-brain barrier. Rasmussen encephalitis is characterized clinically by progressive, drug-resistant focal epilepsy, hemiplegia, and cognitive decline and pathologically by cortical inflammation, neuronal loss, and gliosis confined to one cerebral hemisphere. The Pathology of Rasmussen Syndrome: Stages of Cortical Involvement and Neuropathological Studies in 45 Hemispherectomies. Some doctors use valacyclovir for herpes simplex encephalitis, even though this medication has not been formally approved for the treatment of encephalitis. Coloured coronal magnetic resonance imaging (MRI) scans of the brain of a 25-year-old patient with herpes encephalitis. These patients have auto-antibodies against the NMDR receptor and other surface antigens, suggesting an auto-immune basis for this illness. However, even when PCR, bacterial and viral cultures, serology, and other tests are done, no viral or other pathogen is identified in a significant proportion of patients.
The MRI may show cortical and subcortical signal abnormalities in about 50% of cases and the CSF shows lymphocytic pleocytosis, elevated protein, and oligoclonal bands. Antibodies generated as a result of this sensitization cross the blood-brain barrier and attach to the NMDA receptor on the neuronal membrane. The inflammation consists exclusively of T-lymphocytes and microgial activation with neuronophagia and microgial nodules. Another imaging test, CT (computed tomography) of the face and head can be used to see these changes in the brain. This is an inflammation of the brain caused by an infection with the herpes simplex virus, and has resulted in a large lesion (orange). The degree of brain destruction (especially in the frontal and temporal lobes) and the inflammatory and reactive changes are more severe than any other viral encephalitis and can be detected by imaging.
In the past, the diagnosis of HSV encephalitis required brain biopsy with fluorescent antibody staining using anti-HSV antibodies, microscopic study (to detect inclusions and viral particles) and viral culture.
A necrotizing encephalitis that caused a diffuse melt down of the brain, without predilection for the frontal and temporal lobes. Neonatal EV infection, usually transmitted from the mother, can cause fatal disseminated disease involving the brain, heart, liver, lungs, and other organs. Brain biopsies, done in a few cases, show mild nonspecific changes including perivascular lymphocytes and microglial activation.
This leads to decrease of the NMDA receptor in GABAergic and glutamatergic synapses and increase of extracellular glutamate which causes the symptoms.
In case of encephalitis, the EEG will show an increased or decreased abnormal electrical activity.

Brain biopsy is rarely used, because blood tests and cerebrospinal fluid can provide an accurate diagnosis of encephalitis caused by herpes simplex virus. Because early treatment increases the chances of recovery, it is important that therapy with acyclovir should be started as soon as encephalitis is suspected, even if we do not know the exact cause of the disease. The symptoms usually start with the common symptoms of a viral infection such as fever, headache, muscle aches, feeling tired and nausea.
The lesion is in the brain's right temporal lobe, which is at left in these views from the front.
Atypical cases may have asymmetric pathology, mass-like necrotic and hemorrhagic fronto-temporal lesions, and a wider anatomical distribution, including myelitis and brainstem encephalitis. Most cases of autoimmune encephalitis are caused by antibodies against neural antigens located on the cell membrane. The pathology involves primarily the cerebral cortex and may be focal such that areas of severe cortical damage are bordered by normal brain.
Seizures can be treated with anticonvulsant medications such as phenytoin (Dilantin) or phenobarbital. The scans move from the front of the brain to the back, and are arranged in two rows from upper left to lower right. Hemispherectomy, which is the only cure for the seizures, has provided abundant material for pathological analysis. A ventilator (artificial breathing machine) and other supportive measures can be taken to help the patient who falls into a coma. Inflammation of the brain and its surrounding membranes may result in severe bleeding and cell death in the brain.
When a patient presents with fever, obtundation, seizures, and abnormal CSF, it is preferable to treat with antiviral agents (and antibiotics) rather than defer treatment until the diagnosis is established.
Neuronal damage in Rasmussen encephalitis is thought to be mediated by T-cell cytotoxicity and microglial activation. Sometimes this disease can be caused by viruses that cause mumps, rubella, measles, influenza and mononucleosis (Epstein-Barr virus). Early diagnosis and treatment with anti-viral medication is essential, as the condition has a high mortality rate.
Another group of viruses called arboviruses can spread encephalitis mainly by mosquitoes and ticks bites. However, in patients with HSV encephalitis, prompt treatment saves lives and prevents permanent neurologic deficits. Polio has been eradicated in most of the world but still persists in some developing countries.
Only a small number of people stung by infected ticks or mosquitoes develop symptoms of encephalitis.
Disease caused by arboviruses occurs usually in summer and early fall when mosquitoes bite people who spend more time outdoors.
However, rarely, in some people, the virus can travel in the bloodstream to attack the brain and cause encephalitis. However, before a lumbar puncture you will often need to have a computerised tomography (CT) or magnetic resonance imaging (MRI) scan of your brain to rule out other causes for your symptoms and also to make sure that there are no signs of raised intracranial pressure (raised pressure inside your skull). In some people, encephalitis is diagnosed when other causes for their symptoms have been excluded after tests.
Therapies such as speech therapy and physiotherapy may help to improve symptoms in some people.

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