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Ensefalitis

Definisi

Ensefalitis merupakan radang otak yang ditandai dengan disfungsi neuropsikologis yang fokal ataupun
difus. Secara umum ensefalitis hanya terjadi pada otak (encephalon), akan tetapi sering melibatkan
meningen (meningoensefalitis).

Signs and symptoms

Prodromal karena infeksi virus: demam, sakit kepala, mual dan muntah, letargi, dan myalgia.
manifestasi untuk jenis ensefalitis:

Ensefalitis ec. Varicella-zooster virus (VZV), Epstein-Barr Virus (EBV), cytomegalovirus (CMV),
measles virus atau mumos virus: Rash, lymphadenopathy, hepatosplenomegaly, and
parotid enlargement
St Louis encephalitis: Dysuria and pyuria
West Nile encephalitis (WNE): Extreme lethargy
Gejala klasik yaitu ensefalopati dengan diffuse or focal neurologic symptoms, termasukl:
Perubahan perilaku dan kepribadian, penurunan tingkat kesadaran
Nyeri leher atau kaku kuduk
Fotofobia
Letargi
Kejang umum atau fokal (60% pada anak dengan CE-california virus encephalitis)
Acute confuse atau status amnesti
Flaccid paralysis (10% pada WNE)
Sakit kepala hebat tidak selalu ditemui. Nyeri punggung paraspinal kadang dijumpai.

The signs of encephalitis may be diffuse or focal. Typical findings include the following:

Altered mental status


Personality changes (very common)
Focal findings (eg, hemiparesis, focal seizures, and autonomic dysfunction)
Movement disorders (eg, St Louis encephalitis, eastern equine encephalitis, and western
equine encephalitis)
Ataxia
Cranial nerve defects
Dysphagia, particularly in rabies
Meningismus (less common and less pronounced than in meningitis)
Unilateral sensorimotor dysfunction (postinfectious encephalomyelitis)

Findings of herpes simplex virus (HSV) infection in neonates may include the following:

Herpetic skin lesions over the presenting surface from birth or with breaks in the skin,
such as those resulting from fetal scalp monitors
Keratoconjunctivitis
Oropharyngeal involvement, particularly buccal mucosa and tongue
Encephalitis symptoms (eg, seizures, irritability, change in attentiveness, and bulging
fontanelles)
Additional signs of disseminated, severe HSV include jaundice, hepatomegaly, and shock

Infeksi toxoplasma yang menyebabkan ensefalitis ditemui pada pasien imunosupresi.

Encephalitis may be associated with a number of complications, including the following:

Seizures
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
Increased intracranial pressure (ICP)
Coma

DIAGNOSIS DIFERENSIAL

Diagnostic Considerations
See the following for more information:

California Encephalitis
CBRNE--Venezuelan Equine Encephalitis
Eastern Equine Encephalitis
Encephalitis
Herpes Simplex Encephalitis
HIV-Associated Cytomegalovirus Encephalitis
Japanese Encephalitis
St. Louis Encephalitis
Venezuelan Equine Encephalitis
Viral Encephalitis
West Nile Encephalitis
Western Equine Encephalitis

Other conditions to be considered include the following:

Acute central nervous system (CNS) events, such as hemorrhagic stroke


Acute confusional states secondary to drugs, toxins, psychosis
Amoeba ( Naegleria, Acanthamoeba)
Head trauma
CNS syphilis
Ehrlichiosis
Intracranial hemorrhage
Intracranial tumor
CNS trauma
Differential Diagnoses
Acute Hypoglycemia
Brain Abscess in Emergency Medicine
Cat Scratch Disease (Cat Scratch Fever)
Emergent Management of Subarachnoid Hemorrhage
Herpes Simplex Encephalitis
Herpes Simplex in Emergency Medicine
Leptospirosis in Humans
Meningitis
Pediatrics, Meningitis and Encephalitis
Rocky Mountain Spotted Fever
Status Epilepticus
Systemic Lupus Erythematosus (SLE)
Tick-Borne Diseases, Lyme
Toxoplasmosis
Tuberculosis

WORKUP

Ensefalitis palinf sering siakibatkan karena infeksi virus, meskipun bakteri, fungi, dan autoimun
juga dapat menjadi penyebab penyakit ini.

Blood and urin tests

Serum elektrolit normal-turun (dehidrasi) SIADH- infeksi St. Louis ensefaltiis.


Glukosa darah
Blood urea nitrogen (BUN) dan kreatinin status hidrasi
Tes fungsi hati menilai end-organ dysfunction atau untuk regimen dosis terapi
antimikroba.
Lumbal Puncture (LP) viral ensefalitis. Platelet count dan tes koagulasi pasien kronis
yang mengkonsumsi alcohol, menderita penyakit hati, dan suspek DIC. Pasien-pasien
tersebut harus diberi platelet atau fresh frozen plasma (FFP) sebelum LP.
Tes elektrolit urin perlu jika suspek SIADH. Skrining toksikologi urin dan serum penting
untuk skrining pasien toxic delirium atau sonfusional state.

CT-scan, MRI, dan elektroencephalography