Encephalitis

Evaluation

• Brain MRI
• Lumbar puncture after brain imaging: analysis of CSF for
• • white blood cell analysis (ideally including flowcytometry analysis)
  • protein level
  • glucose level
  • presence for neoplastic cells
  • infectious workup (incl. viral and bacterial analysis in CSF and blood: according to local practice and epidemiology (eg varicella, hepatitis E, HSV1, HSV2, VZV, EBV, HIV,…)
  • lactate
• EEG
• Autoimmune serology: neuronal surface antibodies and/or intracellular neuronal antibodies according to clinical presentation in the serum (except anti-NMDA R Ab are done on CSF (can be done later, therefore keep CSF) –
• ICPi-related encephalitis is an exclusion diagnosis

Management

• Treat with following combination:
• • 1-2mg/kg methylprednisolone IV
  • 10mg/kg 3 x pd acyclovir until PCR for viral infections is negative
  • 2gr 3 x pd ceftriaxone, 500mg 3 x pd metronidazole, 2gr 6x pd ampicilline until negative cultures
  • ICU admission should be considered and cases should be discussed with a neurologist