The diagnosis of encephalitis

For all the variety of clinical manifestations acute encephalitis have a number of common features, which allow to recognize encephalitides process.
Obstipation symptoms are expressed in increased body temperature, changes of the morphological composition of the blood (leukocytosis, left shift formula) and acceleration of ROE, as well as in other common signs of infectious diseases.
Among the cerebral symptoms associated with diffuse inflammatory response of the brain (edema, hyperemia, hypersecretion of cerebrospinal fluid and others)should be considered as violations of the consciousness of different degrees: from light spoor or sunk to a coma. In other cases, there may be agitation, delirium, amantino state. Sometimes there is a General epileptic seizures, fastsikulyarny or myoclonic jerking muscles. In cases of severe disease occurs depression of tendon and periosteal reflexes may be the delay urination. In the final stage of the disease appear human respiration and heart activity.
Meningeal symptoms in varying degrees, almost always accompanied acute encephalitis. The main evidence meningoencephalitis include headache, nausea, vomiting, General hyperesthesia, in the early stages of the disease - the relative slow pulse. Can detect and other objective symptoms of shells: stiff neck, symptoms of Cernica, Brudzinskogo, paralysis of the cranial nerves. The severity of meningeal symptoms can widely vary. When tick and mosquito encephalitis they often are the main in the clinical picture. However, in cases of acute encephalitis proceeding and without distinct clinical signs of the involvement of shells, usually detectable inflammatory changes of cerebrospinal fluid (pleoticus, increase the number of protein, positive globulin reaction Pandi and Nonna-apelt reaction).
Symptoms focal lesions of the brain can be quite varied, depending on the localization of foci inflammatory softening, swelling or infiltration of the brain substance. Often encephalitides symptoms combined with the symptoms of spinal cord (for example, tick-borne encephalitis). The most common manifestations of focal lesions with encephalitis include paresis and paralysis of the limbs of the Central type, sometimes combined with hemihypesthesia, aphasia or dysarthria (slurred speech; in light of the extent of damage is marked only irregularity deep reflexes and abnormal reflexes (Babinski, Rossolimo, Bekhterev, Oppenheim, and others). Sometimes there epileptic seizures, GAK and partial (by type Jacksonian epilepsy). Occasionally acute encephalitis occur hyperkinesis (koreizskiy, choreoathetosis, myoclonus). In cases stem localization process, along with the Central rifling marked diplopia, convergent or divergent strabismus, anisocoria, ptosis, paralysis of the eye, sleep disturbance, eye, facial paralysis, dizziness, problems with swallowing, phonation, articulation, breathing and heart function. Sometimes there are tonic seizures or resistant hypertension muscles. There are also frequent cerebellar symptoms.
The severity focal symptoms can be different, but the detection even erased manifestations of organic brain damage in the background of infectious diseases and meningeal reaction (inflammation of the spinal fluid) give good reasons for the diagnosis of acute encephalitis.
Important in the substantiation of the diagnosis have epidemiological data: stay at the site of infection, contact with infectious patients, the data about the animal bites, tick, on preventive inoculations and other
In unclear cases should be possible to use methods of specific diagnostics: the reaction of binding complement (RAC) in early stages of the disease (tick, mosquito encephalitis, ornitsa, flu and other), the reaction of neutralization of the virus (PH) with paired sera for retrospective diagnosis (with viral encephalitis), reaction suppression of haemagglutination (TPHA), starting from the first week diseases (tick-borne, mosquito encephalitis). In some cases, can be used allergic skin reaction (tick-borne encephalitis, ornitz). Especially important these methods to acquire diagnostic erased and atypical forms. In the period of the epidemic diagnosis of encephalitis may to some extent be based on epidemiological link atypical and typical forms of the disease. However, sufficient credibility he gets only after confirmation of specific methods at least part diseases.
Of great importance for the study of etiological diagnosis, especially at the secondary encephalitis, acquire visceral disorders, such as heart failure in rheumatoid arthritis, the parotid salivary glands in serous meningitis, exanthema in children infectious diseases and other
Often, even when using all possibilities of diagnostics cannot determine the etiological nature of the process.
In such cases must be limited to syndromic diagnosis acute encephalitis, meningoencephalitis or encephalomyelitis.