Pediatric emergency medicine trisk 2633 2633
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (161.58 KB, 1 trang )
DISORDERS THAT PRESENT WITH ENCEPHALOPATHY (SEE
ALSO CHAPTER 17 COMA )
Goals of Treatment
Encephalopathy is an imprecise term that implies diffuse brain dysfunction with
or without alterations in the level of consciousness. Encephalopathy may be a
sign of numerous systemic disorders, or it may result from primary disorders of
the CNS, the most common of which is encephalitis. The emergency physician
must decide whether the child’s degree of irritability, uncooperativeness, and
lethargy is proportionate to the degree of systemic illness; whether it is caused by
fear; or whether it represents cortical dysfunction. Encephalopathy has a large
differential and can be associated with cardiorespiratory compromise, requiring
prompt identification and a systematic approach to evaluation.
CLINICAL PEARLS AND PITFALLS
A detailed clinical history is imperative to identifying a likely etiology.
Herpes simplex virus (HSV) polymerase chain reaction testing of CSF
samples is recommended for all children with suspected encephalitis.
Empiric therapy with IV acyclovir is recommended for all patients with
suspected encephalitis while confirmatory tests are pending.
MRI with diffusion-weighted imaging is the imaging modality of choice
for the evaluation of encephalitis.
Encephalitis
Encephalitis is an inflammation of the brain parenchyma. Meningoencephalitis
refers to additional leptomeningeal involvement, whereas encephalomyelitis
implies involvement of the spinal cord. CNS dysfunction can be caused by direct
invasion of the brain by a pathogen; immunologic mechanisms as in
postinfectious encephalomyelitis, or be mediated by a toxic-metabolite, such as
drugs and toxins.
Viral encephalitides are caused by a wide variety of viruses that lead to
clinically similar illnesses ( Table 97.7 ). An etiology is often not identified, but
when one is, enterovirus is the most commonly identified cause. Prior to
introduction of the vaccine, mumps had been the most common cause of
meningoencephalitis, with up to 50% of patients with mumps parotitis having
