The spectrum of acute encephalitis: causes, management, and predictors of outcome.

Abstract

OBJECTIVE:

To describe and analyze etiologies, clinical presentations, therapeutic management, and outcomes of patients with acute encephalitis and identify outcome predictors.

METHODS:

We conducted a retrospective review of patients diagnosed with acute encephalitis at Mayo Clinic Rochester between January 2000 and December 2012. On the basis of the final diagnosis, the patients were categorized into 3 groups: viral encephalitis, autoimmune encephalitis, and encephalitis of unknown/other etiology. Multivariate logistic regression analysis was used to analyze factors associated with good (modified Rankin Scale scores of 0-2) or poor (scores of 3-6) outcome at hospital discharge.

RESULTS:

We identified 198 patients (100 [50.5%] men and 98 [49.5%] women) with a median age of 58 years (range 41.8-69). Etiologies included viral infection (n = 95, 48%), autoimmune (n = 44, 22%), and unknown/others (n = 59, 30%). Good outcome at discharge was achieved by 48 patients (50.5%) with viral encephalitis, 17 (40.5%) with autoimmune encephalitis, and 32 (54.2%) with unknown/other etiologies. Mortality rates were 8%, 12%, and 5% in each of the 3 categories, respectively. On multivariate regression analysis, the factors that were associated with poor outcome were age 65 years or older (p = 0.0307), immunocompromised state (p = 0.0153), coma (p = 0.0062), mechanical ventilation (p = 0.0124), and acute thrombocytopenia (p = 0.0329). CSF polymorphonuclear cell count was also strongly associated with poor outcome in viral encephalitis (p = 0.0027).

CONCLUSIONS:

Advanced age, immunocompromised state, coma, mechanical ventilation, and acute thrombocytopenia portend a worse prognosis in acute encephalitis. In contrast, the etiology of encephalitis, development of seizures or focal neurologic deficit, and MRI findings were not associated with clinical outcomes.

• Authors: Tarun D Singh, Jennifer E Fugate, Alejandro A Rabinstein
• Journal: Neurology (Neurology) Vol. 84 Issue 4 Pg. 359-66 (Jan 27 2015) ISSN: 1526-632X [Electronic] United States
• PMID: 25540320 (Publication Type: Journal Article)
• Copyright: © 2014 American Academy of Neurology.

Topics

• Acute Disease
• Adult
• Aged
• Brain Diseases (diagnosis, drug therapy)
• Encephalitis (diagnosis, drug therapy, etiology)
• Encephalitis, Viral (diagnosis, drug therapy)
• Hashimoto Disease (diagnosis, drug therapy)
• Humans
• Male
• Middle Aged
• Prognosis
• Sex Factors