Clinical Manifestations of Viral Encephalitis

      Encephalitis can be a part of systemic diseases such as varicella or measles, by itself is the first manifestation of disease symptoms initially. If the encephalitis is not a part of a systemic viral disease, it is likely to be found complaints that precedes neurological syndrome include headache, weakness or malaise, myalgia, complaints of upper respiratory tract disorders and fever. Can be found the presence of nausea, vomiting and stiff neck. The direct effect on the brain characterized by lethargy, confusion, or stupor which can lead to coma. If the patient is not impaired level of consciousness can be found confusion, hallucinations and disorientation, and seizures may also occur, either focal or generalized seizures, and symptoms / signs of other neurological disorders such as hemiplegic, nystagmus, ataxia, anisokor, dysphasia, diplopia, dysarthria and hemianopsia.
      These symptoms may be caused by increased intracranial and cerebral herniation or a result of the slim due to the influence of the virus. Due primarily affects the brain stem, the disorder can occur in the form of pupillary reflexes and oculovestibular. Respiratory disorders and cranial nerves may also occur. The occurrence of ataxia, tremors, and impaired coordination can be caused by dysfunction of the pathways connecting the cerebellum. When infection occurs in mielum, there is also paraplegia, impaired sense of touch and also spingter disorders. While disturbances in the anterior horn cells can cause flaccid paralysis, hypotonia and loss of tendon reflexes without sensory disturbance.

      Symptoms of encephalitis is the triad of fever, seizures and decreased consciousness. The symptoms of viral encephalitis varied, depending on each case, epidemic, type of virus and others. In general, there are 4 types of clinical manifestations, namely:
a. Asymptomatic form of: mild symptoms at all, sometimes there is a mild headache or fever without a known cause. Diplopia, vertigo, and paresthesias also take place peripherally. The diagnosis is established only on CSS examination.

b. Abortive form: The symptoms include headache, high fever and mild neck stiffness. Generally there are symptoms such as upper respiratory tract infections or gastrointestinal.

c. Fulminant form of: This form several hours to several days that ended with the death. In the acute stage: high fever, headache, diffuse great, apathetic, neck stiffness, disorientation, very restless and soon entered into a deep coma. Death usually occurs within 2-4 days due to bulbar or cardiac abnormalities.

d. Typical forms of encephalitis: This form began gradually, early symptoms mild headache, fever, respiratory infection or gastrointestinal symptoms for several days. emerging signs of CNS inflammation (nuchal rigidity, positive Kernig sign, restlessness, weakness and difficulty sleeping). Neurologic deficits that arise depends on the damage. Loss of consciousness leading to coma, may occur focal or generalized seizures, hemiparesis, impaired coordination, personality disorders, disorientation, speech disorders, and mental disorders.

       In herpes simplex encephalitis acute symptoms last for several days. Two clinical state of HSV encephalitis, namely 1) ​​aseptic meningitis syndrome; called aseptic because negative cultures, largely due to a virus, this syndrome indicates involvement of the meninges in HSV encephalitis, commonly called meningoencephalitis; and 2) Acute Encephalitis Syndrome commonly seen in HSV encephalitis.

Aseptic Meningitis Syndrome, among others:
a. Fever 38-40 ° C, usually acute.
b. Headache - usually more severe than the previous headache during fever.
c. Photophobia and pain on movement of the eyeball.
d. Stiff neck as a sign of meningeal stimulation, usually not detected in the initial phase.
e. Examination Kernig and Brudzinski often negative in viral meningitis. Systemic symptoms of viral infection, such as strep throat, nausea and vomiting, weakness of the body, back and waist aches, conjunctivitis, cough, diarrhea, rashes (exanthema).
f. If accompanied by loss of consciousness and changes in the quality of consciousness, perhaps toward a diagnosis of encephalitis.
g. CSF (Liquor cerebrospinalis): normal glucose values​​, and lymphocytic pleocytosis.

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