Acute encephalitis

This devastating disorder was seemingly so bizarre, unexpected, and inexplicable that physicians for years literally refused to believe their eyes. Seven years after the introduction of the drugs into North America, Leo Hollister (1961) reviewed their side effects in the New England Journal of Medicine. In two separate places, he referred to syndromes that probably were NMS. He described a bizarre dystonic syndrome that can be confused with hysteria, tetanus, encephalitis or other acute nervous-system disorders a rare fatality may occur. Later, he mentioned, Other clinical syndromes attributed to central nervous-system effects of these drugs have resembled acute encephalitis, myasthenia gravis, bulbar palsy or pseudotabes. ... 

Rantalaiho T, FarkhUa M, Vaheri A, Koskiniemi M (2001) Acute encephalitis from 1967 to 1991. J Neurol Sci 184 169-177. 

In France 4113109 primary vaccinations during 1968-77 have been surveyed. There were 30 deaths that could have been associated with the vaccine, 23 in the first year of life (62). The relation was considered certain in one case, probable in 5, possible in 6, and doubtful in 18. In the certain case there may have been immunodeficiency. In the second group there were three cases of acute encephalitis. Among the doubtful cases were 12 patients who had neurological symptoms. 

Indications Warm and hot diseases, hot evils internally sinking into the pericardium, phlegm heat gathering and blocking the portals of the heart. Total or partial loss of consciousness due to acute encephalitis, acute meningitis, acute hepatitis, pneumonia, dysentery, uremia, hepatic coma, cerebrovascular accident, infantile convulsions, and schizophrenia... 

The occurrence of obesity was correlated with the neurovirulence of the virus strain (Bernard et al, 1999). Prior vaccination with a vaccinia recombinant coding for CDV surface antigens partially protected against acute encephalitis and obesity (Sixt et al., 1998 Wild et al., 1993). Neuroadapted CDV strain inoculation by other routes (intranasal, footpad, and subcutaneous) does not produce obesity, suggesting that viral replication in the brain is a prerequisite for development of obesity, as suggested by Bernard et al. (1999). 

Viral products are expressed in high levels in the acute stage of infection and at lower levels in the late stage (1 year after infection). Survivors of acute encephalitis complete the elimination of virus-producing cells or suppress expression of viral antigens within a few weeks postinfection (Nagashima et al., 1992). 

Vitamin A intoxication citusing papilledema and simulating acute encephalitis. Acta neuroL scand., 50, 642. 

Acute infection with Hetpes simplex viruses (HSV) results in painful rashes on skin and mucous membranes. HSV-1 mainly causes cold sores around the mouth (hetpes labialis) or eyes (keratitis), whereas infection by HSV-2 mostly results in sores in the genital or anal area. Less frequently, HSV also causes severe infections in newborns or potentially fatal encephalitis. HSV remains latent and can be reactivated by stress, suppression of the immune system or other infections. 

Picornavimses are small, nonenveloped RNA vimses. Members of this family include rhino- and enteroviruses, which are responsible for a variety of human diseases (viral respiratory infection, viral meningitis, myocarditis, pericarditis, encephalitis, chronic meningoencephalitis, herpangina, otitis media, neonatal enteroviral disease, and acute exacerbations of asthma). 

Measles is a severe, highly contagious, acute infection that frequently occurs in epidemic form. After multiplication within the respiratory tract the virus is transported throughout the body, particularly to the skin where a characteristic maculopapular rash develops. Complications ofthe disease can occur, particularly in malnourished children, the most serious being measles encephalitis which can cause permanent neurological injury and death. 

The following factors have been suggested as alternatives to consider when presented with a potential case of exposure to carbon monoxide diabetic ketoacidosis, hypothyroidism and myxedema coma, labyrinthitis, and lactic acidosis toxic exposures resulting in methemoglobinemia ingestion of alcohols or narcotics and diseases that cause gastroenteritis, encephalitis, meningitis, and acute respiratory distress syndrome. 

Suggested Alternatives for Differential Diagnosis Adenoviruses, arenaviruses, California encephalitis, coxsackieviruses, cytomegalovirus, dengue fever, eastern equine encephalitis, echoviruses, infectious mononucleosis, Japanese encephalitis, Lyme disease, meningitis, parainfluenza virus, rhinoviruses, bacterial sepsis, severe acute respiratory syndrome (SARS), St Louis encephalitis, upper respiratory infection, Venezuelan encephalitis, and West Nile encephalitis. 

Signs and Symptoms Symptoms are acute and include fever, headache, encephalitis, vesicular skin lesions at site of the exposure, and variable neurological patterns. Involvement of the respiratory center and death usually occurs in 1-21 days after onset of symptoms. Survivors usually have considerable residual disability. May produce severe permanent neurologic impairment requiring lifelong institutionalization. 

Miller-Fisher syndrome, Bickerstaff s brainstem encephalitis Acute motor axonal neuropathy Immunoglobulin light-chain amyloid neuropathy Cryoglobulinemic neuropathy... 

Other acquired disorders affecting myelin in humans may be secondary to viral infections, neoplasias or immunosuppressive therapy. Acute disseminated encephalomyelitis, also called postinfectious or postimmunization encephalitis, represents a group of disorders usually of mixed viral-immunological etiology. The condition is most commonly related to a spontaneous viral infection, of which major examples are measles, smallpox or chickenpox [1,2]. 

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