What are the treatment principles for viral encephalitis?

Encephalitis refers to an inflammatory lesion caused by the invasion of brain parenchyma by pathogens. The vast majority of causes are viruses, but they can also be caused by infections such as bacteria, fungi, spirochetes, rickettsia, parasites, etc. Some may be allergic diseases, such as acute disseminated encephalomyelitis.

Clinical manifestations

1. Systemic toxic blood symptoms

Fever, headache, body aches, nausea, vomiting, fatigue. A few patients have hemorrhagic rash and myocarditis symptoms.

2. Neurological symptoms

Impaired consciousness, meningeal irritation signs. Flaccid paralysis of the cervical and scapular muscles may occur, causing the head to droop and the arms to be unable to be raised, resulting in the person tottering and helpless. Involvement of cranial nerves and lower limbs is rare. Paralysis can be recovered in 2 to 3 weeks, and about half of the muscles will atrophy. Mild cases may have no obvious neurological symptoms.

Because the location and severity of the lesions vary, the manifestations are varied. Diffuse encephalitis often starts with general discomfort, followed by coma and convulsions, accompanied by fever; brainstem encephalitis often has symptoms such as facial nerve paralysis, choking, dysphagia, limb numbness, weakness and (or) oculomotor nerve paralysis, pseudobulbar palsy, etc. Pseudotumor encephalitis often presents with headache, vomiting, poor limb movement or paralysis, aphasia, mental symptoms, and intracranial hypertension. At the same time, pay attention to the symptoms of the primary disease, such as mumps virus encephalitis accompanied by parotid gland swelling; herpes virus encephalitis with herpes on the skin, coxsackievirus and echovirus encephalitis may have rash, myocarditis, hand, foot and mouth disease, etc. If the lesion involves the meninges (meningoencephalitis), positive meningeal irritation signs will appear.

treat

There is no specific treatment for viral encephalitis. It is particularly important to control intracranial hypertension, hyperthermia and seizures. The airway of a comatose patient must be kept open. Careful care can prevent secondary infection.

1. Symptomatic treatment

(1) Glucocorticoids hydrocortisone or dexamethasone, added to 5% glucose solution and dripped intravenously. Start with a higher dose and gradually reduce it. The course of treatment should not exceed 1 month.

(2) Dehydration and diuresis: 20% mannitol intravenous drip, the course of treatment depends on the condition; or glycerol fructose intravenous drip.

(3) Cooling is mainly done by physical cooling.

(4) Antipsychotic drugs for psychomotor excitement can be given, such as chlorpromazine, fluphenazine or telden, and the dosage should be individualized.

(5) Stress relief

2. Antiviral treatment

(1) Inhibit viral replication in the body, such as acyclovir, iodine, cytarabine, and adenosine.

(2) Prevent viruses from penetrating cells: adamantane and cycloheximide.

(3) Interferon, an antiviral protein produced by human cells, is injected intramuscularly. The course of treatment depends on the condition and should be used early.

(4) Prevent virus adsorption to immunoglobulin G and placental globulin.