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Related Concept Videos

Encephalitis l: Introduction01:19

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
Arboviral Encephalitis01:25

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Arboviral encephalitis refers to brain inflammation caused by arthropod-borne viruses, particularly those transmitted through mosquito vectors. Among these, West Nile virus (WNV), a member of the Flaviviridae family, is a significant public health concern. WNV is an enveloped, positive-sense, single-stranded RNA virus. Human infection typically begins when an infected mosquito introduces the virus into the dermis during feeding. The primary transmission cycle involves birds as amplifying hosts...
Encephalitis ll: Pathophysiology01:26

Encephalitis ll: Pathophysiology

Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
Viral Meningitis01:18

Viral Meningitis

Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
Brain Abscess l: Introduction01:26

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A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...
Bacterial Meningitis I: Introduction01:22

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Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...

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Rhombencephalitis / brainstem encephalitis.

Burk Jubelt1, Cornelia Mihai, Terrence M Li

  • 1Departments of Neurology, Microbiology/Immunology and Neuroscience, SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA. jubeltb@upstate.edu

Current Neurology and Neuroscience Reports
|September 30, 2011
PubMed
Summary
This summary is machine-generated.

Rhombencephalitis (RE) is a brainstem inflammation with infectious, autoimmune, and paraneoplastic causes. Early empiric treatment with ampicillin and acyclovir for Listeria and HSV is recommended for better outcomes.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Rhombencephalitis (RE) is a complex syndrome with diverse etiologies and outcomes.
  • It is often interchangeably used with brainstem encephalitis, despite minor anatomical differences.
  • Etiologic categories include infections, autoimmune diseases, and paraneoplastic syndromes (PNS).

Purpose of the Study:

  • To review the causes, clinical presentations, diagnostic methods, and treatment strategies for rhombencephalitis.
  • To highlight the importance of early diagnosis and empiric treatment for common treatable causes.

Main Methods:

  • Literature review of rhombencephalitis cases and etiologies.
  • Analysis of diagnostic findings including cerebrospinal fluid (CSF) analysis and MRI.
  • Evaluation of treatment outcomes for different causative agents.

Main Results:

  • Listeria monocytogenes is the most common infectious cause, typically affecting young adults with a biphasic illness, CSF pleocytosis, and abnormal MRI. Treatment with ampicillin is effective.
  • Herpes simplex virus (HSV) is another significant infectious cause, with acyclovir treatment dramatically reducing mortality.
  • Autoimmune causes like Behçet disease and paraneoplastic syndromes present challenges in diagnosis and treatment, often with poorer prognoses.

Conclusions:

  • Prompt diagnosis and empiric treatment with ampicillin and acyclovir are crucial for managing suspected rhombencephalitis, especially in cases caused by Listeria and HSV.
  • Further investigations including CSF and blood cultures, PCR, and antibody studies guide definitive treatment adjustments.
  • While treatable causes exist, autoimmune and paraneoplastic rhombencephalitis often have poor outcomes requiring ongoing research.