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Viral encephalitis

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of viral encephalitis.

Alternative Names

West Nile virus

Introduction

Encephalitis is a rare but potentially life-threatening inflammation of the brain that can occur in people of all ages. The most common cause of encephalitis is infection by a virus. In very rare cases, encephalitis can also be caused by bacterial infection, parasites, or complications from other infectious diseases. This report focuses on viral encephalitis.

Encephalitis: Viral Infection of the Brain

Many viruses can cause encephalitis. The West Nile virus, for example, has been responsible for high-profile outbreaks in the U.S. Most people exposed to encephalitis-causing viruses have no symptoms. Others may experience a mild flu-like illness, but do not develop full-blown encephalitis.

In severe cases, the infection can have devastating effects, including:

• Swelling of the brain ( cerebral edema )
• Bleeding within the brain ( intercerebral hemorrhage)
• Nerve damage

The damage may cause long-term cognitive or physical problems, depending on the specific areas of the brain affected.

Other Viral Infections of the Central Nervous System. Viral infection and inflammation can affect multiple areas of the central nervous system, and is categorized by its location:

• Meningitis: infection of the meninges (the membranes that surround the brain and spinal cord)
• Meningoencephalitis: infection of both the brain and meninges
• Encephalomyelitis: infection of the brain and spinal cord

Specific Viruses Implicated in Encephalitis

Encephalitis caused by viruses in the United States generally fall into the following groups:

• Arboviruses are the primary cause of acute encephalitis (sudden-onset encephalitis caused by direct infection). Arboviruses, short for "arthropod-borne viruses," are spread by mosquitoes and ticks.
• Enteroviruses , such as coxsackievirus
• Herpes viruses are the other major cause of encephalitis in the U.S. This virus family includes herpes simplex, Epstein-Barr, cytomegalovirus, and varicella-zoster.
• In rare cases, secondary encephalitis can develop following childhood viral diseases such as measles, mumps, and rubella.

See the "Causes" section in this report.

How Viruses Can Infect the Central Nervous System

Encephalitis can develop shortly after an initial viral infection, or it can develop when a virus that was lying dormant in the body suddenly reactivates. Viruses are simple, but powerful infectious organisms.

• The virus infects a person (host) by penetrating a cell membrane and ejecting its genetic material (its DNA or RNA) into the cell.
• The viral DNA or RNA takes control of important cell processes, telling the cell to make more viruses.
• The cell ruptures, releasing new viral particles that infect other cells.

There are two ways that viruses can infect brain cells:

• The virus silently invades the body. There are no initial symptoms. The virus is carried by the bloodstream to the nerve cells of the brain, where they gather and multiply. Viruses that enter the brain in this manner are often widely scattered throughout the brain. This is called diffuse encephalitis.
• A virus first infects other tissue and then proceeds to invade brain cells. Viruses that are transmitted from other tissues usually cause focal infection, meaning they produce extensive damage in only a small area of the brain.

The Central Nervous System The brain and spinal cord comprise the central nervous system. The adult human brain weighs approximately 3 pounds (1.4 kilograms). There are two major parts of the brain: The higher and larger forebrain (the cerebrum) The lower and smaller brain stem The Cerebrum The cerebrum is the uppermost and largest part of the brain. It is the most highly developed section of the brain. There are several components to the cerebrum: The Cerebral Cortex . The cortex is the outermost layer of the cerebrum. It is made of gray and white matter: Gray matter is a thin sheet of nerve cells that cover the surface of the brain. White matter is a bundle of insulated nerve fibers that underlies the cortex and makes up the core of the cerebral hemispheres. The Hemispheres. The two hemispheres control higher brain functions, such as memory, learning, decision making, and processing input from the senses. They are each divided into four lobes, which regulate different brain functions: Frontal lobe: This is the brain's "gatekeeper." It controls higher motor functions, including speech, and governs concentration, attention, inhibition, judgment, and personality traits. Parietal lobe: Processes information from the senses and controls walking, posture, and head and eye movements. Occipital lobe: Responsible for interpreting visual input from the eyes. Temporal lobe: Responsible for interpreting auditory input from the ears. Also regulates how language is interpreted and retrieves information for memory storage. The Basal Ganglia. The basal ganglia are clusters of gray matter within each of the lobes. They are important for coordinating voluntary muscle movement, balance, and posture. The Limbic System. The limbic system is located deep in the cerebrum and controls interpretation of smell, instinctive behavior, emotions, and drives. Brain Stem The brain stem is responsible for all vital functions. It is divided into the following areas, which are responsible for specific functions: Medulla: sleep, breathing, heartbeat, digestion, activation of higher forebrain functions Pons: sleep, breathing, motor control, activation of higher forebrain functions Cerebellum: movement coordination Midbrain: walking, posture, head, eye movement Hypothalamus: body temperature, appetite, sexual behavior, reproductive hormones Thalamus: communication with higher forebrain The Spinal Cord The spinal cord extends out of the base of the skull through the vertebrae of the spinal column. It is continuous with the brain. Thirty-one pairs of nerves extend from the sides of the spinal cord to other parts of the body (the peripheral nervous system). The Meninges and Cerebrospinal Fluid The meninges are three membranes that enclose the brain and spinal cord. They contain cerebrospinal fluid, which protects the central nervous system from pressure and injury.

• Review Date: 1/18/2007
• Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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