Encephalopathy and encephalitis are acute brain diseases. Both are rare and potentially deadlier forms of disease conditions that may lead to permanent brain damage or death. In both cases, the patient shows a similar altered mental status. It is very easy to confuse encephalopathy with encephalitis. Although the words sound similar, they are different conditions.
The following differences can be seen in causes, signs, symptoms, and laboratory tests of encephalopathy and encephalitis:
- The brain itself is swollen or inflamed in encephalitis, whereas in encephalopathy, the altered mental state occurs due to several types of health problems. However, encephalitis can cause encephalopathy.
- Encephalopathy has many causes, but mainly it is due to a trauma or an injury, may have ill-defined pathology and can be interchangeably used with the term encephalitis. However, encephalitis always has very well-defined infective causes such as viruses or bacteria (rarely due to the abnormal immune response of the body).
- In encephalitis, the patient commonly gets a fever, headache, flu-like symptoms, vomiting, and stiff neck and affects the specific region of the body (focal neurological signs) such as one-sided paralysis, which is uncommon in encephalopathy.
- Depressed mental status may show a steady deterioration in encephalopathy, but it may fluctuate in a patient with encephalitis.
- Generalized types of seizures are common in encephalopathy that affects the whole brain, whereas generalized partial (focal) seizures are common in encephalitis that may affect a limited area of the brain.
- In the blood test, increased white blood cell count (leukocytosis) and abnormal spinal fluid (pleocytosis) tests are very commonly seen in encephalitis due to infections that are uncommon in encephalopathy.
- Encephalitis often shows symptoms of infection that can be detected in laboratory tests, whereas encephalopathy is a gross brain dysfunction that could be due to many reasons such as drug effect, toxins, or lack of oxygen and can even clinically be detected.
- Magnetic resonance imaging (MRI) often shows normal reports in encephalopathy. However, in encephalitis, MRI reports may show abnormal focal points due to infection.
Early diagnosis and treatment are important because it is very difficult to predict the symptoms of encephalitis in each patient. A serious condition affecting the brain requires immediate treatment to reduce the risk of lasting complications or death.
What is encephalopathy?
Encephalopathy is a clinical syndrome (a group of disorders) that damages the brain resulting in brain dysfunction.
The symptoms of encephalopathy are as follows:
- Trouble thinking clearly or focusing
- Behavioral changes
- Memory loss
- Personality changes
- Trouble speaking
- Rapid uncontrolled eye movements
- Trouble swallowing
- Muscle weakness, tremors, or twitching
- Reduced or loss of consciousness
It may be caused by metabolic abnormalities such as diabetes, liver failure, kidney failure, prolonged exposure to toxins (solvents, lead-containing paints, industrial chemicals, and certain metals), alcohol abuse, drug abuse, thiamine deficiency, radiation, brain tumor, or increased pressure in the head, poor nutrition, trauma, and lack of oxygen or blood flow to the brain.
What is encephalitis?
Encephalitis is a specific type of encephalopathy that is most infectious in origin. It occurs due to infective causes such as viruses (herpes simplex virus [HSE], chickenpox virus, varicella virus, German measles virus, Epstein-Barr virus, human immunodeficiency virus [HIV], cytomegalovirus [CMV], and enteroviruses], bacteria, fungus, and rarely due to abnormal immune system response. The patient may experience the following:
- Unusual behavior
- Personality changes
- Emotional lability
How are encephalitis and encephalopathy detected?
Your doctor/neurologist may examine for concentration, memory, and other mental tasks. To differentiate the type of encephalopathy or encephalitis, they may order
- Blood and urine tests.
- Spinal fluid sample (taken by inserting a needle into your spine) test.
- Computed tomography (CT) scan.
- Magnetic resonance imaging (MRI).
- Electroencephalography (EEG).
How are encephalopathy and encephalitis treated?
Depending on the specific cause of encephalopathy and encephalitis, your neurologist may decide the treatment plan. Early detection and treatment of the underlying cause are essential to reverse or limit the effects of encephalopathy or encephalitis.
If an infection is detected in your blood and spinal fluid tests, your doctor may recommend
- Antivirals such as Zovirax (acyclovir) for a viral infection.
- Antibiotic treatment for a bacterial infection.
- Antifungal treatments for fungal encephalitis.
Moreover, immunotherapy and other supportive care treatments such as lots of fluid intakes, dietary changes, nutritional supplements, and bed rest are important for faster recovery.
Treatment of encephalopathy may vary depending upon the type and severity of the disease. Your doctor may provide specific instructions for proper care and treatment. Depending upon the symptoms, your neurologist may also suggest
- Medications such as carbamazepine and Eptoin (phenytoin) to stop seizures.
- Sedatives to calm agitation.
- Steroids such as prednisolone to reduce inflammation.
- Pain relievers such as ibuprofen.
- Anti-inflammatory medication to reduce swelling.
- Water pills (diuretics) such as Lasix (furosemide) to reduce the pressure in the head.
- Oxygen treatment to ease with breathing.
- Speech therapy, occupational therapy, and physiotherapy to manage longer-lasting symptoms.
- Dialysis (blood purification using a machine) or an organ transplant if liver or kidney problems are the cause (in severe cases).
- Occasionally head surgery to reduce the pressure inside the skull.
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Medscape https://emedicine.medscape.com/article/186101-overview https://emedicine.medscape.com/article/791896-overview
NIH: National institute of neurological disorders and stroke: https://www.ninds.nih.gov/Disorders/All-Disorders/Encephalopathy-Information-Page
Quist-Paulsen E, Kran AB, Lindland ES, et al. To what extent can clinical characteristics be used to distinguish encephalitis from encephalopathy of other causes? Results from a prospective observational study. BMC Infect Dis. 2019;19(1):80. Published 2019 Jan 22. doi:10.1186/s12879-018-3570-2.
Brain and spine organization https://www.brainandspine.org.uk/our-publications/our-fact-sheets/encephalitis/
Brain foundation: https://brainfoundation.org.au/disorders/encephalitis/
National organization of rare disease: https://rarediseases.org/rare-diseases/rasmussen-encephalitis/
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