00:02
So, how do you manage patients with encephalitis?
Well, if they are very sick,
obviously, they have to be monitored
in the intensive care unit.
00:13
Now, do you have to isolate them?
We certainly don't have to
isolate them for herpes virus.
00:19
They're not contagious if they
have herpes encephalitis
We certainly don't have to
isolate them for herpes virus.
00:19
They're not contagious if they
have herpes encephalitis
unless they have some sort of
active lesion on their mouth,
genitalia
or some kind of rash consistent.
00:31
So, generally, you don't have to isolate patients with herpes virus
and certainly you don't have to isolate
them if it's been caused by a mosquito
unless the hospital is rampant
with mosquitoes, which is unusual.
and certainly you don't have to isolate
them if it's been caused by a mosquito
unless the hospital is rampant
with mosquitoes, which is unusual.
00:45
But if it's just encephalitis of unknown cause,
then respiratory or contact isolation would be prudent.
00:53
If they have seizures, you’re going to manage
those seizures with benzodiazepines acutely,
and you would maintain them on fosphenytoin IV.
01:05
And the certainly increased intracranial
pressure can occur and is dangerous,
so the neurosurgeons will often put
a continuously monitoring lead for
increased intracranial pressure.
01:22
Corticosteroids may also be required;
and if it's very severe,
hyperventilation and IV mannitol.
01:34
Lumbar punctures need to be avoided
in patients with increased intracranial pressure
due to the scare of herniating.
01:46
As far as empirical therapy goes,
sometimes you can't tell
what's causing the encephalitis.
01:53
So, what you’ve got to do is treat everybody
as if they had herpes simplex encephalitis
and give IV acyclovir.
02:02
And that's the goal.
02:04
There's no proven benefit in other forms of encephalitis.
02:09
Now, if you know the patient also has influenza,
if the viral studies indicate influenza,
we would give oseltamivir,
which is a neuraminidase inhibitor.
02:20
But looking at the mechanism of action,
it doesn't honestly make a lot of sense that it
would work well in the central nervous system,
and so we need more
data on whether it works.
02:33
Nevertheless, we don't have
anything else to do.
02:36
And the treatment with oseltamivir is relatively benign.
02:41
So, in somebody with influenza
encephalitis, we would give it.
02:46
Rabies is essentially untreatable,
although there are one or two
patients who have survived this.
02:54
And this was accomplished with inducing
a coma and giving IV ribavirin.
03:05
In other words, we essentially induced
coma in the patient with proven rabies
and gave the patient enteral amantadine.
03:14
And this was done on a 15-year-old girl.
03:18
Her survival was reported in
The New England Journal of Medicine.
03:22
So, using that model,
we are treating patients
with that kind of a model.
03:30
But there have been patients treated
that way that have not survived.
03:34
And that brings us to the end
of our discussion about encephalitis.