Encephalitis

Many viral infections can lead to encephalitis, or inflammation of the brain, a condition marked by fever, headache, nausea, drowsiness, speech and hearing impairment, and (in some cases) seizures and coma. The condition, while frightening, is usually not contagious, and most children who develop it survive without brain damage.

HOW DOES ENCEPHALITIS DEVELOP?
Depending on its cause, encephalitis can occur as an isolated case, a localized outbreak or an epidemic. Most often, encephalitis is a complication of a common viral infection, such as chicken pox, Coxsackie virus (which causes a severe sore throat), hepatitis, influenza, herpes or Espstein-Barr. In the days before vaccines, encephalitis might follow a bout with measles, the mumps, polio or rubella. Dozens of other viruses carried by mosquitos or ticks can also cause encephalitis.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS ENCEPHALITIS?
Those at highest risk for developing encephalitis are infants recovering from viral illnesses. Although some of the symptoms of encephalitis are common to many illnesses, others strongly suggest encephalitis. One such symptom is intense pain occuring when the child bends the neck forward to touch the chin to the chest. A stiff neck, back, arm or leg also may suggest the condition. In general, however, encephalitis is a possibility any time a child suffers an apparent relapse in the final stages of recovery from a viral illness. Another clue is the speed with which symptoms develop—they may come on quite suddenly and worsen rapidly.

IS MEDICAL ATTENTION NECESSARY?
Absolutely. If a child develops a constellation of symptoms suggesting brain inflammation, particularly after a viral illness, he should be taken to a hospital emergency room immediately.

HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS ENCEPHALITIS?
A child suspected of having encephalitis will be hospitalized for diagnostic tests and care. A lumbar puncture (also called a spinal tap) is performed to detect white blood cells in the cerebrospinal fluid, a sign of infection. An electroencephalogram (EEG) charts brain waves and may show a slowing of brain activity that accompanies encephalitis, and a computed tomographic scan (CT scan) can show the characteristic brain swelling. Blood tests can sometimes identify the cause of the infection.

WHAT TREATMENTS ARE AVAILABLE?
Hospital care is mostly supportive—letting the infection run its course while keeping the child as comfortable as possible. Medications are determined by which organism is behind the infection. Antiviral drugs, such as amantadine, are sometimes administered; if the cause is a herpes virus, the drug acyclovir may be used. Docors may also administer cortisone to lessen inflammation and anticonvulsants to fight seizures.

WHAT ARE THE CHANCES OF COMPLETE RECOVERY?
The likelihood of complications depends upon the cause of the encephalitis. Fortunately, the more common causes have very low complication rates and are hardly ever fatal. A few types, however, are quite dangerous. In Eastern equine encephalitis, an infection that also affects horses and is transmitted by mosquitos, the death rate is 60 percent, and survivors are virtually always left with neurologic problems. Herpes encephalitis has a death rate of 25 percent.

Recuperation takes about two to three weeks after the child is released from the hospital. Continued bed rest is essential, along with good nutrition. If any muscles are stiff or weak, daily exercise or physical therapy may be necessary for a short while. Home care is simply a matter of regaining strength. When the child is eating and feeling well and is alert and strong, he can return to school.

GETTING HELP
Call your doctor if your child:

• Develops a headache accompanied by fever, pain when the neck is stretched and sensitivity to bright light

• Develops neurological symptoms (double vision, unequal pupil size, hearing impairment, personality changes) that increase in severity over several hours

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.