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Viral Encephalitis
November 2000

Q. My 24-year-old daughter was diagnosed with viral encephalitis after she was found in a coma. Some 4 months ago after 1 week in the ICU on a respirator and 2 weeks in the hospital, she was released. However, she continues to be in a very poor condition and has been readmitted to a different hospital where they have done an MRI scan and a lumber puncture. The doctors say they have found something wrong with the white blood cells. They also said something is showing on the MRI scan that is worrying them. When we ask what the problem is, we just get told the results are inconclusive. Please, what are the likely implications of the above?

A. Viral encephalitis is an infection of the brain and usually involves the lining of the spinal cord as well. Viruses are the most common cause, although there are several other organisms such as fungi, parasites and even TB (tuberculosis) that can cause encephalitis. Symptoms commonly include an altered level of consciousness, with confusion and disorientation. There may be various weakness and other focal neurologic symptoms. The chief way to confirm diagnosis is by lumbar puncture (spinal tap), where there are an increase number of white blood cells. There other specific studies namely spinal fluid PCR amplification of viral nucleic acid to test for various specific viruses. One of the most common virus causing encephalitis is Herpes Simplex Virus (HSV). In the past, often a brain biopsy was needed to confirm this diagnosis, but now, PCR amplification has made the need for brain biopsy much less common. Acyclovir is an antiviral medication that may be useful for treatment, particularly if it is started early. Unfortunately, in your daughter's case, it sounds like she had a very severe case given that she was found in a coma. The prognosis is much poorer when one is starting out with more severe neurologic dysfunction. However, her young age is beneficial in prognosis compared with the elderly.

It is difficult to comment on the brain MRI with out having more details. Although it is not uncommon even after all of the above testing is done to not be sure what the cause of the encephalitis is. One other illness can sometimes mimic encephalitis, and that is Lupus. This should be ruled out if not already done (via blood tests).

I'm sure that there are various specialists involved with your daughter's case already, including infectious disease, and neurology. I'm sorry I can not be of more help, but my best wishes are with you and your daughter. The included reference may be very helpful as it is specifically an encephalitis support site.

Ref: http://glaxocentre.merseyside.org/1outcome.htm

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