Encephalitis - Acute Conditions

Creutzfeldt-Jakob Disease (and Variant)

AKA mad cow disease Prions -Particles smaller than virus resistant to sterilization process -Cross blood-brain barrier and cause cell death May lie dormant for decades before causing neuro degeneration Symptoms are progressive with no treatment; fatal Diagnostics -Immunologic assessment of CSF -EEG -MRI

Encephalitis

Acute inflammatory or infectious process of the brain tissue

Encephalitis Nursing Management

Comfort measures to reduce headache Seizure precautions Neuro assessments Prevention education Using insect repellant Clothing to cover extremities Early identification of increased ICP

Varient CJD S/S

Early symptoms are psychiatric Behavioral changes Sensory disturbance Lim pain Muscle spasms and rigidity Dysarthria Incoordination Cognitive impairment Sleep disturbances

Encephalitis causes

Majority of known causes are viral -Herpes simplex virus -West Nile virus Lesser known causes are autoimmune, bacterial, fungal, or parasitic Can occur as a focal lesion or diffuse (effects whole brain)

CJD S/S

Mental deterioration Ataxia Visual disturbances Memory loss Involuntary movement Paralysis Mutism

Herpes Simplex Virus Encephalitis

Most common cause of acute encephalitis in the United States Fever, headache, behavioral changes, confusion, hallucinations can lead to focal seizures, dysphasia, hemiparesis, altered LOC EEG and CSF exam used to diagnose -High opening pressure -Normal glucose -High protein levels Antiviral agents are treatment choice -Acyclovir (Zovirax) -Ganciclovir (Cytovene)

Fungal Encephalitis

Occur rarely in healthy people; more often in immunocompromised disease or meds Occurs by fungal spores being inhaled and infecting the lungs; then enters the bloodstream and eventually CSF Fever, malaise, headache, meningeal signs, altered LOC, cranial nerve dysfunction CSF evaluation reveals elevated white cells and protein; decreased glucose MRI is used Anti-fungal meds; seizure precautions; shunting of CSF -Fluconazole (Diflucan) -Flucytosine (Ancobon) Amphotericin B administered when conventional meds fail -Administer diphenhydramine and acetaminophen prior

CJD and variant CJD Nursing Management

Supportive and palliative care Prevent injury because of immobility and dementia Promote patient comfort Prevent disease transmission -Standard precautions -Disposable equipment in the OR

Arthropod-Borne Virus Encephalitis

transmitted by mosquitoes, drain/sewer flies, ticks, sand flies "no see-ems" West Nile or St. Louis virus May start as flu-like symptoms then progress St. Louis encephalitis has SIADH with hyponatremia Fever, headache, dizziness, nausea, and malaise Can lead to seizures and coma CSF evaluation, MRI Immunoglobulin M antibodies found in serum of West Nile virus Symptom management as there is no specific treatment