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Saturday, 30 November 2013

Encephalitis - The Misdiagnosis and Diagnosis

Encephalitis is defined as a condition of irritation and swelling (inflammation) of the brain, as a result of virus, bacteria and others invasion.
A. Misdiagnosis
It is important to differentiate encephalitis correctly from other disorders that may cause similar neurological symptoms and which may have very different treatments, including include bacterial meningitis, stroke, brain tumours, drug reactions and metabolic disturbances. In a report on Encephalitis Global community study (a sad story) Mcgraw wrote " He (My son) went to an emergency room 4 times in 3 days. He had high white blood cell counts, was complaining of chest pain, arm numbness and a general feeling of feeling very very ill. His first diagnosis was Rhabdamyolisis and (you guessed it) sinisitus. They gave him saline drip for a few hours then sent him home with pain pills and doxycycline. Second time his diagnosis was just sinusitis, sent home with more pain pills. Third time, (another common diagnosis) the flu! He went back 2 times on the third day, and was refused a bed. I believe the phase was "you are not dying so you don't get a bed". Noticable on his admittance papers: his signature by the third admittance looked like he could no longer remember how to spell his name. He WAS given a CT scan each time, but for his chest. Blood work was also done, which did not match his diagnoses"
  and "Two days later he can not walk, hold any thing, is in horrible pain and very disoriented, seizing, hallucinating. He goes to a different ER. They decide that since my son drank beer daily that he was now in alcohol withdrawal. He is also in full blown kidney failure. They call three hospitals before they find one who can deal with his "withdrawal". He is admitted to the third hospital. Kidney failure dealt with and he is sedated"  Finally "Within 12 hours he has no gag reflex, no cough reflex, eyes not tracking or focusing. On life support. No reaction to pain. GCS is 12-14 for 3 days. No LP or MRI preformed yet. Yet they have decided to give him antibiotics and have diagnosed pneumonia. Admitted Sat, MRI finally done Tues. At this time it was discovered that he had massive swelling in his brain stem. He never came out of the coma and died after being on life support for 8 days. disturbances."(34)

B. Diagnosis
After taking the physical exam and medical history, depending to the symptoms of the patient and to rule out the similar symptoms with different diseases. In the report by the Royal Melbourne Hospital, Dr. Knox J, and the researchers indicated that a suspected but unproven case of Murray Valley encephalitis virus (MVEV) infection to illustrate some of the challenges in clinical management. It remains difficult to establish an early diagnosis of MVEV infection, and there is a lack of proven therapeutic options(35).
1. Brain Scans
Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI)
The aim of the test is to look for the extent inflammation of brain and rule out other similar symptoms of different diseases, including stroke, brain tumours, aneurysms, etc.

2. Electroencephalogram (EEG)
Electroencephalogram (EEG) is a measure of brain waves of that allow your doctor to see how your brain functions over a certain time. Any abnormal patten may provide evidence of in encephalitis, such as slowing of brain activity....

3. Lumbar puncture (LP)
Lumbar puncture (LP) or spinal tap is a diagnostic and at times therapeutic procedure allows a doctor to test the sample the cerebrospinal fluid (CSF) surrounded the brain and spinal cord and exam  under the microscope to assess the number and type of white blood cells in differentiation between viral or bacterial infections.

4. Serological tests
blood, urine, as well as other body fluids can also help to detect brain and/or spinal cord infection. Serological tests is the study of antibodies presented in the cerebrospinal fluid against a specific viral agent or by polymerase chain reaction that amplifies the RNA or DNA of the virus responsible.

5. Etc.
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Sources
(34) https://www.inspire.com/groups/encephalitis-global/discussion/misdiagnosed-2/
(35) http://www.ncbi.nlm.nih.gov/pubmed/22432670