Post Encephalitic Syndrome

post encephalitic syndrome, encephalititis lethargica

1. “Post encephalitic psychiatric
sequelae”
Clinical LaisonPsychiatry,
11/09/2010

2. •Encephalitis refers to an inflammation of the brain
tissues.
•It can involve different regions of the brain and can be
caused by different etiological agents. Whether directly
or through immunological reaction not clear. ( more of
viral cause in this context)
• In many cases it is followed by complete remission, but
can also infrequently result in transient or persisting post
encephalitis sequalae.
•These sequalae can manifest as a wide variety of clinical
presentations, which pose challenges to clinicians in the
realms of diagnosis and management.

3. •3.5 to 7.4 per 100,000 patient years.
•HSV most common sporadic cause in
western world.
•Epidemic of viral encephalitis is
increasing. (HIV)
•Clinical presentation.
•Encephatitis lethargica.

4. ICD –F 07
•Personality and behavioural disorders due
to brain disease, damage and disfunction.
•F 07.0 organic personality disorder
•F 07.1 post encephalitic syndrome
•F 07.2 post concussional syndrome.
•F07.8 other
•F07.9 unspecified

5. POSTENCEPHALITIC
SYNDROME ( ICD)
•A syndrome which includes residual behavioral change
that follows recovery from viral or bacterial encephalitis.
•The symptoms are nonspecific and depend on the
individual, the infectious agent, and the age of the
individual at the time of the infection.
• The disorder is often reversible, in contrast to the
organic personality disorders.
• The symptoms of the disorder include general malaise,
apathy or irritability, learning difficulties, altered sleep
and eating patterns, and changes in sexuality and in
social judgment.
•There may be a variety of residual neurological
dysfunctions such as paralysis, deafness, aphasia,
constructional apraxia and acalculia.

6. •JE associated with psychiatric presentations like social
inappropriteness, aggression , emotional lability,
affective and paranoid symptoms ( monnet 2003)
•HSV , EBV acute presentations with psychiatric
syndromes.
•Fatigue syndrome after 6 months of glandular fever.
•Kluver-Bucy syndrome after herpes encephalitis, tick-
borne encephalitis lead to fatigue, memory problems
•Mood changes at recovery.
•Influenza epidemic, sydenhams chorea SSPE, PANDAS

7. Encephalitis lethargica
•Von Economo. 1917
•Influenza like prodrome with variety of
nervous manifestations like distuburbed
sleep, lethargy, disturbance of ocular
movements.
•Psychiatric symptoms +
•Post encephalitic psychosis depression,
hypomania, catatonic symptoms, ocd
mutism.

8. Present day Encephalitis lethargica
•Sporadic cases.
•Dale et al 2004 report 20 cases with
classic neuropsychiatric manifestations.
•Immune mediated like in PANDAS.
•Clinical relevance is to keep a high index
of suspicion and psychiatric symptoms
may be the predominant manifestation.
•Whether catatonia related to encephalitic
processes?