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Encephalitis, Emergency Medicine

Mary Saunders Reviewed 06/2017



  • Acute inflammation of the brain

  • 20,000 cases in US annually

  • Mortality: 10%

  • Inflammatory reaction occurs within brain parenchyma with destruction of neurons, parenchymal edema, and petec...


Signs and Symptoms

  • Often begins with a preceding flulike illness over a few days:

    • Mild headache, fever, sore throat, reduced appetite, myalgias

  • Altered level of consciousness, drowsiness, coma

  • I...



Stabilize. Treat seizures 

Initial Stabilization/Therapy

  • ABCs:

    • Intubate patients who are obtunded/comatose/absent gag reflex

  • Naloxone, thiamine, glucose (or Accu-Chek) for altered me...



Admission Criteria

All patients 

Pearls and Pitfalls

Empiric treatment for HSV-1 infection with acyclovir should always be initiated as soon as possible if the patient has encephalitis without apparent explanation to decrease morbidi...

Additional Reading

  • Fitch  MT, Abrahamian  FM, Moran  GJ, et al. Emergency department management of meningitis and encephalitis. Infect Dis Clin North Am.  2008;22(1):33–52.

  • Long  SS. Encephalitis ...



  • 049.9 Unspecified non-arthropod-borne viral diseases of central nervous system

  • 058.29 Other human herpesvirus encephalitis

  • 323.9 Unspecified causes of encephalitis, myelitis, and encephalomyel...

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