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meningoencephalitis
Etiology:
1) viral infection
- HSV1 typically causes acute (not subacute) encephalitis [3]
2) fungal infection
a) Cryptococcus neoformans (cryptococcosis)
- subacute & chronic meningoencephalitis in immunocompromised patients [3]
b) Mucor
3) parasitic infection:
- Toxoplasmosis
- amebiasis (rapidly progressive, within days)
4) rickettsial infection
5) bacterial infection
a) tuberculosis
b) Listeria
c) Mycoplasma
6) vascular diseases
7) abscess or empyema
8) tumors
9) Reye syndrome
10) toxic encephalopathy
11) subdural hematoma
12) systemic lupus erythematosus
Pathology:
- inflammation of the brain parenchyma as well as the meninges
- elevated intracranial pressure (cryptococcosis. others?...) [5]
Clinical manifestations:
1) manifestations of meningitis
a) headache
b) fever
c) nausea/vomiting
d) photophobia
e) others
2) altered level of consciousness
3) delirium
4) focal or diffuse neurologic signs
a) aphasia
b) ataxia
c) hemiparesis with hyperactive DTR & extensor plantar responses
d) myoclonic jerks
e) cranial nerve palsy
5) seizures (50% of patients with severe encephalitis)
6) hypothalamic-pituitary dysfunction
a) temperature dysregulation
b) diabetes insipidus
c) SIADH
Laboratory:
- see ARUP consult [2]
Interactions
disease interactions
Specific
amoebic meningoencephalitis
viral meningoencephalitis
General
encephalitis
meningitis
References
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 2312-14
- ARUP Consult: Encephalitis, Infectious
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/encephalitis-infectious
- NEJM Knowledge+ Question of the Week. Nove 20, 2018
https://knowledgeplus.nejm.org/question-of-week/540/
- Abassi M, Boulware DR, Rhein J.
Cryptococcal meningitis: diagnosis and management update.
Curr Trop Med Rep 2015 Jun 1; 2:90.
PMID: 26279970 Free PMC Article
- NEJM Knowledge+
- National Institute of Neurological Disorders and Stroke (NINDS)
NINDS Encephalitis and Meningitis Information Page
https://www.ninds.nih.gov/Disorders/All-Disorders/Meningitis-and-Encephalitis-Information-Page