Encephalitis of the brain: symptoms and treatment

Encephalitis of the brain is a whole group of inflammatory diseases of this organ, and the inflammation can be is caused not only by an infectious agent, but also by infectious-allergic processes, the action of toxic substances. Consequently, the cause of encephalitis of the brain is great. Encephalitis, caused by each specific cause, has its own characteristics, but the common signs, however, persist. Symptoms of encephalitis are diverse and depend on the area of ​​brain damage. Treatment depends on the cause and is aimed at restoring the brain tissue and its functions. In this article you can get acquainted with the main causes, symptoms and methods of treatment of encephalitis.

Causes of encephalitis

Encephalitis can be an independent disease, in which case it is primary. If encephalitis develops within the general disease (that is, it is one of the symptoms), then it is called secondary.

The causes of primary encephalitis can be:

• viruses (arboviruses that cause tick-borne and mosquito encephalitis, Coxsackie and ECHO viruses, herpes viruses, rabies virus and so on);
• microbes and rickettsia (causative agents of syphilis, typhus).

The causes of secondary encephalitis are:

• viruses (rubella, measles, chicken pox, influenza, HIV);
• vaccination (doses of DPT, against measles, rubella);
• bacteria (staphylococci, streptococci, mycobacterium tuberculosis);
• parasites (toxoplasm, chlamydia, malarial plasmodium).

Separately, isolated situations, when the cause of encephalitis development are allergic and toxic processes in the brain, but such cases are much less common. An infectious agent is most often the cause of encephalitis.

Symptoms

Encephalitis is a disease that is accompanied by a whole group of symptoms. They can be divided into:

• general inflammatory reactions of the body;
• cerebral symptoms;
• focal symptoms (indicating which part of the brain is affected).

Depending on the cause of encephalitis (infection, allergy or toxic effects), a particular group of symptoms may be more severe. For example, in encephalitis with a bacterial and viral origin, the general inflammatory reactions of the body will be expressed more significant than with the allergic nature of the process, but the diagnosis of encephalitis is valid only in the presence of all three groups symptoms.

Common inflammatory responses of the body

After the incubation period (the time from the moment the pathogen enters the body before the appearance of the first symptoms), general weakness, malaise, feeling of weakness and fatigue develop. Disturbed sleep, appetite. There is an ache in the body and muscles, there is a feeling of "twisting" in the joints. The body temperature rises to 38 ° C - 40 ° C. There may be manifestations of catarrh of the upper respiratory tract (mucous discharge from the nose, swelling in the throat, coughing and so on) or the occurrence of gastrointestinal disorders, there may be a rash in the body. All these symptoms are nonspecific (they occur in other diseases) and depend on the type of pathogen. Not every encephalitis is accompanied by all the listed symptoms.

General cerebral symptoms

This subgroup of symptoms includes:

• impaired consciousness;
• headache;
• dizziness;
• nausea and vomiting;
• sensitization of the senses;
• generalized seizures;
• mental disorders.

Disturbance of consciousness can range from minor confusion (the patient is slightly inhibited and does not immediately answer questions) to coma. And the coma can develop almost instantly.

Headache is almost an obligatory sign of encephalitis. It can be the most diverse in nature (stupid, sharp, aching, pulsating, shooting, drilling, etc.) and intensity, tends to increase. Headache can be associated with intoxication of the body, and may be a result of impaired blood circulation and circulation of the cerebrospinal fluid.

Dizziness also tends to increase, can be accompanied by nausea and vomiting, the latter not always bringing relief and can be repeated many times.

Characteristic is the so-called hyperesthesia (increased sensitivity) of the sense organs: light and noise, the perception of tactile touches as painful.

Generalized epileptic seizures can be one of the first signs of encephalitis. They appear as a result of irritation of the brain tissue.

Mental disorders in encephalitis are acute and emotionally excessive manifestations. Usually these are crazy ideas, hallucinations and even psychoses. The patient can suddenly develop a psychomotor agitation, in which he completely does not control his actions and behaves inadequately. Just like other general cerebral symptoms, mental disorders can increase. There is a situation where after a fit of hallucinations or psychomotor agitation the patient falls into a coma.

Focal Symptoms

In patients with encephalitis, weakness develops in the limbs and a sensitivity disorder.

The inflammatory process can cover absolutely any area of ​​the brain tissue, although for some pathogens are characterized by "favorite" places of defeat, but, in most cases, these places are predicted it is impossible. Depending on which area of ​​the brain is involved, such symptoms will arise. It can be:

• paresis and paralysis: a decrease in muscle strength. And it can be a subtle weakness with active movements (akin to fatigue), or maybe a complete lack of even the ability to move a limb. Weakness can grow gradually, but can immediately be quite pronounced;
• violation of muscle tone (both upward and downward);
• impaired sensation: loss of sensation of touch or difference between cold and hot, sharp and blunt touch. The same group includes a peculiar disorder of sensitivity, when the patient can not understand which part of the body the doctor is holding him and to which the party makes a passive movement (for example, the doctor with the eyes closed patient touches the index finger of one of the hands and bends it in direction of the palm, and the patient generally does not feel the touch and direction of movement or can not correctly name the serial number of the finger and where to bend);
• speech disorders: loss of the ability to understand or reproduce speech. It is not at all necessary that the loss of speech will be complete. There are options when the patient can not pronounce individual words or sounds, confuses similar words and letters, not understands the meaning of complex verbal constructions (for example, can not correctly answer the question: "Glory above Nikita. Who is the tallest? ");
• loss of ability to read, write and count;
• loss of ability to recognize a familiar object by touch: asteroognosis (for example, if you put a pen or match box in your hand, then with closed eyes the patient will not be able to determine what kind of object it is);
• disturbance of balance and coordination disorders: unsteadiness in walking and standing, impossibility get your finger into the motionless object, miss when trying to take a spoon or a glass in arms;
• hearing impairment, tinnitus;
• memory loss;
• falling out of the fields of vision, a sense of looking "into the pipe
• incorrect visual perception (for example, large objects seem small, loss of distinction between the left and right sides, and so on);
• violation of the combined movements of the eyeballs (turns to the sides, up and down);
• the appearance of involuntary movements in the limbs and trunk: twitching, flinching, swinging hands, twists of the trunk, nodding his head, grimacing, trembling of hands and feet, and similar movements;
• Parkinsonism symptoms;
• loss of control over the function of urination and defecation;
• defeat of the cranial nerves (the face looks skewed, strabismus arises, eyelids drop, vision impairment, loss of taste, neuralgia of the trigeminal nerve, impaired speech intelligibility, difficulty in swallowing, nasal congestion, choking, and others symptoms);
• mental disorders: inadequate behavior, foolishness, unmotivated aggression, and others.

It should be understood that in each specific case, only one of the above listed can be present from the focal symptoms, and maybe several. Everything depends on the extent of the lesion.

Encephalitis of the brain can be accompanied by the development of meningeal syndrome.

Changes in cerebrospinal fluid

Encephalitis is characterized by the appearance of inflammatory changes in cerebrospinal fluid (cerebrospinal fluid). It is obtained by carrying out a spinal puncture. With encephalitis, the pressure of the CSF increases, the content of cells (lymphocytes and / or neutrophils) increases, the protein content increases, in some cases, an admixture of erythrocytes (for example, with chickenpox encephalitis, influenza encephalitis) can be detected, a slight increase in the content Sahara. Also in the cerebrospinal fluid, antibodies to the causative agent of encephalitis can be detected and identified by disease.

Encephalitis is a serious illness of the nervous system. In addition to general infectious, cerebral and focal symptoms, encephalitis is almost always accompanied by a change in blood pressure, a violation of cardiac activity and respiration. A serious complication of encephalitis can be the development of cerebral edema with the displacement of some of its departments, which can cause compression of vital centers of respiration and palpitation, and the latter is fraught with deadly outcome.

For each variety of encephalitis, some features of the flow are characteristic (for example, measles encephalitis develops against a specific rash). Knowing these features helps the doctor in diagnosis.

Treatment

Treatment of encephalitis should be carried out only in hospital settings, and sometimes in conditions of resuscitation.

If to generalize all methods of treatment of encephalitis, then there are three directions:

• etiotropic: aimed at eliminating the cause of encephalitis;
• pathogenetic: the use of drugs to influence the mechanisms of damage to the brain tissue;
• symptomatic: allows you to eliminate certain symptoms.

Thus, the treatment of any encephalitis is based on a combination of these directions.

Etiotropic treatment

Since the most common cause of encephalitis is infectious, the following can be used as a means of etiotropic treatment:

• antibiotics: effective if the pathogen is bacteria. Usually they are used intravenously, in large dosages. It is possible and endolumbar introduction (with spinal puncture). Since the species of the bacterium can be difficult to determine, and there is usually no time to wait for the results of sowing of the cerebrospinal fluid on special media, then antibiotics of a wide spectrum of action are used. These are groups of drugs, such as cephalosporins of III-IV generation, aminoglycosides, carbapenems. Fluoroquinolones, which are antimicrobial agents, but not entirely antibiotics, can be used;
• antiviral drugs: this is a fairly extensive group of medicines. Against some viruses, there are specific antiviral agents (Acyclovir - against the herpes virus). In general, antiviral drugs do not have a narrow focus. As an etiotropic treatment of this group of drugs, nuclease (RNA-ase), Cycloferon, Ribavirin, Viferon, Groprinazine (Isoprinazine), Amixin (Tyloron, Lavomax), Proteflazide and others are used;
• human immunoglobulin: it is used in severe cases, for example, in tick-borne encephalitis.

Pathogenetic treatment

To this end, use:

• glucocorticoids (hormone therapy): used with anti-inflammatory, anti-edematous and anti-allergic. In severe cases, pulse therapy is used with a short, but high-dose course;
• decongestants: to combat brain edema, which can lead to the death of the patient. Effective anti-edema drugs include Mannitol, Mannitol followed by Furosemide (Lasix), L-Lysine escinate, Glycerol, Diacarb (Acetazolamide);
• desensitizing drugs (anti-allergic): Loratadine, Tavegil, Erius, Zodak, Dimedrol, Suprastin and others;
• Infusion therapy: the introduction of a sufficient amount of fluid intravenously with the correction of metabolic disorders for maintenance of homeostasis (Trisol, Rheosorbylact, Reopoliglyukin, potassium preparations, Sodium bicarbonate, Dextran and others);
• substances that improve microcirculation and angioprotectors: Pentoxifylline, Instenon, Cavinton;
• antihypoxants: Actovegin, Glycine, Cogitum, Coenzyme Q10, Mexidol, Cytochrome C and others;
• metabolic drugs and vitamins: Phenibut, Phenotropol, Pyracetam, vitamins C, B, E;
• anti-inflammatory drugs: Nurofen (Ibuprofen), Xefokam and others;
• cardiovascular drugs: for correction of cardiac arrhythmias, changes in blood pressure;
• means for correcting the function of breathing: providing a sufficient amount of oxygen (oxygen therapy), hyperbaric oxygenation, in severe cases, intubation of the trachea and artificial ventilation lungs.

Symptomatic treatment

This area includes the application of:

• anticonvulsants such as Sibazon, Valproate, Diphenin, Thiopental sodium and others;
• antipsychotic drugs for the correction of mental disorders. These drugs are Haloperidol, Sibazon, Aminazine, Ludomil, Amitriptyline and the like;
• antipyretic, such as Paracetamol, Ibuprofen, lytic mixture;
• means, stimulating neuromuscular transmission: Neuromidine, Proserin (for elimination of paresis);
• drugs that reduce muscle tone (Midokalm, Sirdalud);
• Neuroleptics (elimination of involuntary movements): Triftazine, Haloperidol, Sonapaks, Ridazine;
• antiparkinsonian preparations: L-Dofa, Akineton, Parkopan and so on.

After getting out of acute condition with encephalitis, patients need to carry out restorative measures. This is necessary in order to minimize the effects of destruction of the brain tissue. Depending on the symptomatology, the patient is shown various physiotherapy procedures, therapeutic exercises, massage, speech therapy, electrostimulation. The courses prescribe neurometabolites, antioxidants, vitamins. Often the residual phenomena after the encephalitis transferred are epileptic seizures that require the constant reception of anticonvulsants.

The most active recovery occurs within the first year after the encephalitis. It is not always possible to help the patient completely get rid of the symptoms that have arisen during the development of encephalitis. There are situations when the residual effects after the transferred encephalitis become the cause of disability.

Thus, encephalitis of the brain is a formidable neurological disease that can result in complete recovery, as well as disability or even fatal outcome. Symptoms of the disease depend on the cause of encephalitis, which is often infectious. For treatment, it is necessary to use a wide range of medicinal products at the same time, and recovery after a previous illness can be delayed for several months and even more.