Infection–associated encephalopathies—their investigation, diagnosis, and treatment

Abstract

Reduced level of consciousness is a common clinical finding in acutely sick patients. In the majority of cases a cause for the encephalopathy is readily identifiable,whilst in a minority the aetiology is more difficult to ascertain. Frequently the onset of encephalopathy is associated with, or follows, infection. The mechanisms through which infection leads to encephalopathy are diverse. They range from direct microbial invasion of the brain or its supporting structures, to remote, infection-triggered mechanisms such as acute disseminated encephalomyelitis. Most common however, is the encephalopathy caused through a remote effect of systemic sepsis-septic encephalopathy. This article discusses the clinical presentation and underlying pathogeneses of the acute encephalopathies associated with infection, aiming to aid both their recognition and treatment.

A misleading case of encephalitis in cirrhotic diabetic patient: The importance of early diagnosis

“…Main diagnostic investigation includes brain CT scan, MRI and CSF examination with HSV DNA detection by PCR. Early diagnosis and prompt therapy with acyclovir, particularly within 48 hours after hospital admission, are of primary importance to improve prognosis, reducing morbidity and mortality [2,3] . In this clinical case report, the initial absence of neurological signs was misleading.…”

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

“…The clinical characteristics of AHLE are quite similar to those for ADEM, but AHLE may preferentially affect the brainstem, and as the name suggests, the lesions are hemorrhagic. Red blood cells, as well as polymorphonuclear cells, are generally present in the CSF of patients with AHLE, whereas OCBs are rare [60][61][62].…”

“…The mass effect associated with these lesions can be life-threatening, and measures to reduce brain swelling, including hypothermia and craniectomy, may be needed [72][73][74][75]. In addition to demyelination, pathology in AHLE shows fibrinoid necrosis of small vessels [62]. Outcome is poor in patients who have AHLE, with mortality approaching 70% [62].…”

“…In addition to demyelination, pathology in AHLE shows fibrinoid necrosis of small vessels [62]. Outcome is poor in patients who have AHLE, with mortality approaching 70% [62]. Patients with ADEM have a much better outcome, but approximately one third of them will go on to develop MS [76].…”

A case of acute encephalopathy with hemophagocytic lymphohistiocytosis and clonal T-cell expansion

“…Encephalopathy is a heterogeneous group of disorders of the brain that are characterized by altered states of consciousness, altered cognition or personality, and seizures [1]. It is distinguished from encephalitis by the absence of cerebrospinal fluid pleocytosis.…”