Imaging in adult patients with acute febrile encephalopathy: What is better computerized tomography or magnetic resonance imaging.

Context: Imaging techniques are commonly used by emergency physicians in a febrile comatose patient. Their utility requires judicious use of the available resources. In this study, we have compared the efficacy of cranial imaging techniques in adult patients with acute febrile encephalopathy. Materials and Methods: This prospective observational study enrolled 101 patients presenting to the emergency with fever of less than 15 days duration and altered sensorium. All the patients were subjected to routine investigations, detailed cerebrospinal fluid analysis, computerized tomograms (noncontrast followed by contrast enhanced), and magnetic resonance imaging of the brain. Final diagnosis was reached after considering the clinical, biochemical findings, imaging results, and response to therapy. The positive yield of radiological investigations was compared against the final diagnosis. Results: The patients were divided into three groups. Forty-eight had evidence of meningoencephalitis, 22 patients had pyogenic meningitis, and 20 were combined together in other group. In 12 patients, a definitive diagnosis could not be made. Only 37% patients were detected to have abnormal computerized tomograms and the most common abnormality was diffuse edema, which failed to point to an etiological diagnosis. Magnetic resonance imaging was abnormal in 62.75% cases and was able to suggest an etiological diagnosis in 100% cases of cerebral venous thrombosis, tubercular meningitis, 95% cases of meningoencephalitis, and 45% patients with meningitis. Conclusions: We can conclude that magnetic resonance imaging provides better information than computerized tomography in adult patients with acute febrile encephalopathy.

Clinical and etiological profile of acute febrile encephalopathy in eastern Nepal.

Objective. To investigate the clinical and etiological profile of acute febrile encephalopathy in children presenting to a tertiary care referral center of Eastern Nepal. Methods. 107 children (aged 1 month to 14 yr) presenting to the emergency with fever (> 380 C) of less than 2 wk duration with altered sensorium with/ or without seizure were prospectively investigated for etiological cause. The investigations included blood and CSF counts, blood and CSF cultures, peripheral smear and serology for malarial parasite, and serology for Japanese encephalitis (JE) virus. Other investigations included EEG and CT or MRI wherever indicated. Results. The most common presenting complaints apart from fever and altered sensorium were headache and vomiting. Convulsions, neck rigidity, hypertonia, brisk deep tendon reflexes, extensor plantar response and focal neurological deficits were seen in 50%, 57%, 22.4%, 28%, 39.3% and 9.3% of the subjects, respectively. The diagnoses based on clinical presentation and laboratory findings were pyogenic meningitis in 45 (42%), non JE viral encephalitis in 26 (25%), JE in 19 (18%), cerebral malaria in 8 (7%), herpes encephalitis and tubercular meningitis in 4 (4%) each, and typhoid encephalopathy in 1 case. Conclusion. Pyogenic meningitis and viral encephalitis including JE are the most common causes of acute presentation with fever and encephalopathy. Preventive strategies must be directed keeping these causes in mind.

Encefalomielopolirradiculoneurite herpética em pacientes imunocompetente: relato de caso / Herpecti encephalo-myelo-polyradiculoneuritis in immunocompetent patients: case report

Os autores relatam o caso de um paciente com encefalomielopolirradiculoneurite herpética pelo vírus herpes simplex. Ë feita uma análise do caso e revisäo dos diferentes aspectos clínicos, incluindo epidemiologia, fisiopatologia, quadro clínico, diagnóstico, tratamento e prognóstico. Por tratar-se de emergência neurológica, é fundamental a administraçäo imediata de terapia específica no intuito de diminuir a mortalidade

Canine distemper virus infection with secondary Bordetella bronchiseptica pneumonia in dogs

Canine distemper virus infection and secondary Bordetella bronchiseptica pneumonia are described in mongrel dogs. Canine distemper was characterised by nonsuppurative demyelinating encephalitis with typical inclusion bodies in astrocytes. B. bronchiseptica was isolated from areas of purulent bronchopneumonia.

Encefalitis Viral / Viral Encephalitis

Los virus se constituyen en una causa importante de encefalitis y meningoencefalitis en la edad pediátrica. Entre los implicados están el del sarampión, parotiditis, adenovirus, arbovirus, familia herpes virus, rabia, rubeola, entre otros. La encefalitis se ha definido como la inflamación del cerebro y las manifestaciones clínicas son diversas, siendo el resultado de la respuesta a este proceso inflamatorio, con hallazgos neurológicos específicos de acuerdo a las áreas del parénquima cerebral afectadas y que dependen del tipo de virus y de la respuesta inmune del individuo. El diagnóstico está basado en la historia clínica y el examen físico, complementado con estudios del líquido cefalorraquídeo, imagenología y cerología. El tratamiento es en general inespecífico, empírico y su objetivo es el de mantener la vida del paciente, prevenir y manejar las complicaciones. Se busca de este modo, llamar la atención sobre esta enfermedad, ya que el diagnóstico precoz y el tratamiento oportuno y adecuado, mejoran el pronóstico, disminuyen las secuelas y la mortalidad

Encefalitis herpética neonatal. Conceptos actuales a propósito de un caso / Current concepts and case report of neonatal herpetic encephalitis

El propósito de este reporte es presentar el caso de un recién nacido con infección por virus de herpes simple tipo 2 en sistema nervioso central. El diagnóstico se sospechó por las manifestaciones clínicas de la paciente y se confirmó por cultivo y detección de DNA de VHS en el líquido cefalorraquídeo. Se presentan conceptos actuales en cuanto a patogénesis, diagnóstico y tratamiento de esta infección viral en el período neonatal

Handbook of zoonoses; section B: viral

Rocio viral encephalitis is an acute severe neurological human disease caused by a Flavivirus which lends its name to the disease