Encephalitis is acute inflammation of brain tissue. Though itself a rare condition, it is most commonly due to viral infection such as influenza, herpes, measles, or mumps, to name a few. Many of us remember contracting chickenpox as children, but the virus that causes chickenpox is also a known cause of viral meningitis. Providers misdiagnosing encephalitis for a psychiatric condition or minor viral process may cost crucial time to treat a sick patient.

Encephalitis symptoms come on suddenly and severely. They may include fever, lethargy, headaches, personality changes, and confusion. Infants with encephalitis will often also exhibit bulging fontanelles.

Diagnosing the condition requires a full history, including documenting recent illnesses, physical examination, possible neurological exam, brain imaging, a spinal tap, and/or an electroencephalogram (where the patient has electrodes placed all over his skull to monitor brain activity). While the physical and neurological examinations may reveal possible origins of the virus and the brain areas affected by inflammation, the MRI will actually show the inflammation of tissues and lead to a conclusive diagnosis.

If the encephalitis is determined to be bacterial, antibiotics will be started. Viral encephalitis, however, requires supportive care and antiviral medications. In almost all cases of encephalitis, treatment requires hospitalization.

Misdiagnosing encephalitis may be due to clinician’s focus on psychiatric illness, or not recognizing the severity of the symptoms as presented. Tragically, the patient’s psychiatric symptoms like personality changes and confusion may be confused for mental illness. Complications from misdiagnosis may include permanent brain damage and or death. Promptly beginning care, however, is critical and can prevent these terrible outcomes.