In encephalitis, or inflammation of the brain, the brain becomes inflamed due to bacteria, viruses, fungi, or other pathogens. Depending on the cause and severity, paralysis, loss of consciousness, and hallucinations may occur. In most cases, rapid intensive medical treatment for encephalitis is necessary.
What is encephalitis?
Schematic diagram showing the anatomy and structure of the brain. Click to enlarge. The name encephalitis is composed of the ancient Greek word for brain and the suffix -itis, which stands for inflammatory disease. So it is an inflammation of the brain, and it often has severe consequences. Depending on the degree of inflammation, symptoms range from headaches, fatigue and tiredness to impaired vision or speech, paralysis, hallucinations, convulsions and loss of consciousness. Neck stiffness, disorientation, fever and nausea may also occur. The inflammation may also affect the spinal cord or meninges. Patients with encephalitis usually feel very ill and need (intensive) medical treatment as soon as possible! The best known encephalitis is tick-borne early summer meningoencephalitis (TBE), but there are many other forms of brain inflammation.
Causes
Encephalitis is most often caused by viruses. For example, influenza, mumps, measles, rubella, rabies, and herpes viruses can cause encephalitis. Ticks also transmit viruses that can lead to encephalitis. This form is called early summer meningoencephalitis (FSME). But other pathogens can also trigger the inflammations in the brain: Bacteria (for example, those from typhoid fever, syphilis, listeriosis, and Lyme disease), fungi, and, in rare cases, parasites (for example, worms). Finally, processes in autoimmune disease or multiple sclerosis can also trigger encephalitis. People with a disturbed or weakened immune system are particularly at risk, and encephalitis also often affects infants and the elderly.
Symptoms, complaints, and signs
The symptoms of encephalitis depend on which region of the brain is affected. In many cases, the disease heals completely. However, deaths or chronic courses with long-lasting neurologic deficits are also possible. In the case of a viral infection, the disease begins with non-specific symptoms that can also occur in other diseases. These include fever, headache, muscle pain, fatigue and nausea. After that, the symptoms specific to encephalitis appear. Thus, there are sudden disturbances of consciousness and states of confusion. Concentration and memory are severely impaired. Particularly striking are behavioral changes that manifest themselves in constant mood swings, delusions, hallucinations and disorientation. Vomiting also occurs frequently. At the same time, neurological deficits occur, such as disturbances in speech as well as paralysis of the arms, legs or eye muscles. Sometimes seizures are observed. If the meninges are involved, neck or back stiffness also occurs. Permanent seizures (status epilepticus) or cerebral edema are observed as complications. In the context of cerebral edema, there is also dizziness, constant headaches, and nausea and vomiting. Depending on the localization of the edema, disturbances of consciousness up to coma, visual disturbances, breathing difficulties, slowing down of all movements or constant hiccups are possible. Because both complications are potentially life-threatening, intensive emergency medical care is required when these symptoms occur.
Diagnosis and course
Because the symptoms of encephalitis are fairly typical, a physician usually has a suspicion after describing the symptoms and admits the patient to the hospital. There, other diseases must be ruled out and the suspicion confirmed. A blood test provides initial indications of inflammatory processes and defense reactions in the body. An examination of the cerebrospinal fluid (CSF puncture) provides more precise information about the type of encephalitis. The attending physician can use magnetic resonance imaging or computer tomography to rule out tumors or brain hemorrhages. In addition, brain swelling, which almost always occurs in connection with encephalitis, can be detected.Despite rapid medical treatment, the course of encephalitis is sometimes tragic: In some types of bacterial encephalitis, the mortality of patients is 50%. In other types, for example TBE, 2% of those affected still die. Apart from that, severe complications are possible. In the worst case, mental disabilities, paralysis or seizures can remain from encephalitis.
Complications
Serious complications and, in the worst cases, death can result from encephalitis. Usually, areas of the brain are irreversibly damaged and paralysis or hallucinations occur. If the disease progresses, the affected person may also lose consciousness or fall into a coma. Life expectancy is drastically reduced in untreated encephalitis. Severe headaches and fever also occur. The patient suffers from a general feeling of weakness. Concentration and coordination are also weakened, and there are often disturbances of consciousness or disorientation. The patient’s quality of life is extremely reduced and ordinary daily life is usually no longer possible. Diagnosis of encephalitis is relatively simple, so treatment can begin early. Antibiotics are administered, which in most cases lead to a positive course of the disease. Complications occur when encephalitis has not been treated for a long period of time and irreversible damage to the brain has occurred. Paralysis may persist or the patient may fall into a coma. In most cases, a prolonged stay in the hospital is necessary.
When should you see a doctor?
People who complain of a sudden decrease in performance should see a doctor. If there is a headache, a feeling of pressure inside the head, or a general feeling of pain in the body, a doctor should be consulted. The same applies to fever, dizziness or nausea. If vomiting, nausea or disturbances of the digestive process occur, medical advice should also be sought. If functional disorders set in, a doctor must be consulted. Problems with vision, hearing, or taste are considered unusual and should be sought medical attention. If symptoms persist for several days or increase in intensity, a physician is needed. If there is a general feeling of malaise, inner weakness, fatigue or restlessness, a doctor should be consulted. If there are disturbances of consciousness or a loss of perception, an emergency doctor is needed. First aid measures are required until the doctor arrives. There is a life-threatening condition where immediate action is required. Mood swings or problems with orientation require an examination. If there are cramps, paralysis or problems with the muscular system, a doctor should be consulted. If there are noticeable changes in behavior, a general feeling of illness, or mental abnormalities, a visit to the doctor is necessary to determine the cause.
Treatment and therapy
Treatment of encephalitis depends largely on which pathogen caused the illness. In bacterial encephalitis, antibiotics are used to prevent the bacteria from spreading and to kill them. There are also drugs that kill fungi, called antifungals. For viruses, targeted drugs can only be used to some extent. For many types of viruses, there are no killing agents yet. In addition to fighting the causes, the symptoms of encephalitis must be treated. Pain is relieved, fever is reduced, and the circulation is stabilized if possible. Brain swelling is often treated with cortisone. If a patient is unconscious and/or if breathing and circulation are severely impaired, artificial respiration must be used. If the cause of the encephalitis cannot be elucidated or if it involves viruses for which there are no effective drugs, often only the symptoms can be treated. Treatment takes place in the hospital because of the need to respond quickly to paralysis, convulsions, and other symptoms. Intensive medical treatment and hospitalization for several weeks is often necessary. The sooner the diagnosis is made and treatment begins, the greater the chances of beating encephalitis.
Outlook and prognosis
The prognosis for patients with encephalitis varies depending on the age of the affected person.Young children and seniors are considered particularly at risk. Depending on the type of virus causing the disease and the extent of brain areas affected, the disease tends to be gravid. While many people recover completely, in severe cases the disease can be fatal or cause permanent brain damage. The outcome depends as much on how quickly treatment is given. In most cases, people with very mild encephalitis or meningitis can make a full recovery, although the process can be slow. Patients who have only a headache, fever, and stiff neck may recover in 2-4 weeks. In bacterial meningitis, affected individuals usually show relief 48-72 hours after initial treatment. However, complications from the disease are more likely in this case. In particularly severe cases, this form of the disease can lead to hearing and/or speech loss, blindness, permanent brain and nerve damage, behavioral changes, cognitive disabilities, lack of muscle control, seizures, and memory loss. Those patients may require long-term therapy, medications, and supportive care.
Prevention
Effective vaccinations are available against some agents that cause encephalitis. Vaccination against measles, mumps, and rubella, for example, is usually given to young children. One can also be vaccinated against FSME. You can protect yourself against Lyme disease by wearing long clothing and using repellents to avoid tick bites as much as possible. Some pathogens, such as syphilis, are sexually transmitted. Here condoms protect.
Aftercare
Aftercare for encephalitis should be followed under any circumstance. If the affected person is already under medical treatment, the doctor’s instructions should be strictly followed. It is important for the patient to rest during such inflammation. There should be no physical exertion. The intake of medications should also be observed at all times. Often the strong painkiller cortisone is prescribed, this should continue to be taken even after the symptoms are relieved. Immunoglobulins are applied to filter out the antibodies from the blood of the affected person. This medication may be administered for days. In addition, during the follow-up of encephalitis, the formation of new antibodies should be avoided or prevented as much as possible. This is possible by strengthening and hardening the immune system. This kind of hardening of the immune system happens through a mild chemotherapy that the person being treated should undergo. Each patient expresses different symptoms of encephalitis and is therefore treated individually. The aftercare should also be adjusted accordingly. Even if the symptoms no longer seem too severe, rest and further drug treatment should be mandatory. If these guidelines are followed, then the perfect aftercare is guaranteed in the case.
This is what you can do yourself
Encephalitis is a serious condition that should not be treated by yourself under any circumstances. If encephalitis is suspected, a doctor must be consulted immediately. In its early stages, encephalitis can be mistaken for the onset of a cold. Typical signs are fever, nausea and fatigue. Often other symptoms such as stiff neck, confusion, paralysis and cramps as well as unconsciousness occur. Anyone who notices such symptoms in themselves should not experiment with over-the-counter medications, but should immediately visit the nearest hospital. The best known is the tick-borne early summer meningoencephalitis. Specific self-help measures are possible against this form of brain inflammation. First, tick bites should be avoided, especially in high-risk areas. To do this, it is best to take some precautions. Insect repellents can deter ticks. Wearing long pants and long-sleeved tops makes it harder for insects to bite. After returning from the outdoors, check your own body and that of any pets for ticks. There is a vaccination against the disease that is recommended especially for people who regularly spend time in high-risk areas. A strong immune system can help to prevent encephalitis from breaking out in the first place, heal more quickly or be milder.The body’s defenses are best strengthened by a healthy lifestyle, especially a largely plant-based diet rich in vitamins, as well as by getting enough sleep and abstaining from stimulants such as tobacco or alcohol.
