Pediatric Encephalitis

Rifngatun Nadhiroh*, Tigor Yeheskiel**

* Clerkship of Medical Faculty University of islamic Malang
** Radiologist of Blambangan Hospital

Background
Encephalitis is a rare, but serious, condition of neurologic dysfunction due to inflammation
of the brain parenchyma and may be caused by infections or autoimmune conditions. Diagnosis is
typically made by a combination of clinical, laboratory, neuroimaging, and electrophysiologic
findings. To distinguish encephalitis from other causes of encephalopathy, key features include
presence of fever, CSF pleocytosis, or MRI or EEG changes compatible with encephalitis.1
Computed Tomography (CT), Magnetic Resonance Imaging (MRI), laboratory and
electrophysiologic findings is recommended for patients with encephalitis.
Case Description
A 3-year-old men complained of seizure since the age of 1 years, complaints accompanied by
fever (<390C), then seizures occur with a frequency of 1-2 minutes with a resting phase in each
spasm. Seizures usually occur 2-3 times a week. Besides the central nervous system disorders in
the form of muscle weakness so that the patient is slow to walk and imbalance in motor movements
or ataxia. Then, patient comes to the radiology department and undergoes non contrast MSCT
examination.
Discussion
 Brain parenchymal inflammation associated with neurologic dysfunction is the strict
definition of confirmed encephalitis.2 Herpes simplex virus (HSV), varicella-zoster virus (VZV),
and enterovirus are 3 of the most commonly identified etiologic agents in acute encephalitis.1
The International Encephalitis Consortium (IEC) created simplified consensus diagnostic
criteria for a standardized case definition of encephalitis and encephalopathy of presumed
infectious or autoimmune etiology. 3, Altered mental status for over 24 hours without an alternative
cause is required as evidence of neurologic dysfunction. In addition, supplemental minor criteria
must be present (2 for possible, ≥3 for probable or confirmed): fever ≥38°C within 72 hours,
seizures, new focal neurologic findings, cerebrospinal fluid (CSF) pleocytosis (≥5 white blood
cells/μL), neuroimaging with brain parenchymal changes or electroencephalogram (EEG)
consistent with encephalitis.4,5,6
Encephalitis can be diagnosed by CT Scan and laboratory test. In this case the patient feel a
similar complaint, seizure experienced by patient arise from the age 1 years, with fever (<390C),
disorientation, deficit neurologist and from physical examination, no abnormaitas were found, this
can occur because the patient condition is not possible, meningeal sign negative. CT Scan revealed
a leptomeningeal enhancement picture.5,6 Based on patient complaints, the clinical picture and
radiological examination support that this encephalitis.
Conclusion
Encephalitis results from inflammation of the brain parenchyma. The basic diagnosis of
encephalitis is based on clinical manifestations and CT Scan which produces a picture of
leptomeningeal enhancement.5
Reference
1. Venkatesan A, Geocadin R. Diagnosis and Management of Acute Encephalitis: A Practical
Approach Neurology: Clinical Practice. 2014;4(3):206-215.
2. Messacar K, et.al. Encephalitis in US Children: HHS Public Access. Published in final edited
form as: Infect Dis Clin North Am . 2018 March ; 32(1): 145–162.
doi:10.1016/j.idc.2017.10.007.
3. Hasbun R, et.al. Epidemiology of Meningitis and Encephalitis in Infants and Children in the
United States, 2011–2014: Original Studies. The Pediatric Infectious Disease Journal • Volume
38, Number 1, January 2019.
4. Granerod, J. , et.al. Neuroimaging in Encephalitis: Analysis of Imaging Findings and
Interobserver Agreement: Clinical Radiology. 2016.
5. Bykowski J, et.al. Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part
of The California Encephalitis Project: Pediatric Neurology 52.2015.606-614.
6. Levis, P, et.al. Encephalitis: Pediatrics in Review. The online version of this article, along with
updated information and services, is located on the world wide web at:
http://pedsinreview.aappublications.org/cgi/content/full/26/10/353.2005;26;353-363