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Guide for General Practitioners

Encephalitis: A Guide for General Practitioners

General practitioners (GPs) are often the first port of call for many people with a brain injury and are an important ally in their journey to recovery. In developing this guide we hope we can support GPs by providing evidence-based and up-to-date information to help with recognising and managing the acute symptoms and effects of an ABI. We also cover the unique challenges inherent in diagnosing encephalitis (inflammation of the brain) and managing associated consequences.

The information included here is aimed primarily at GPs but may be of interest to other healthcare professionals, particularly those in primary care such as practice nurses and professions allied to medicine.

This guide has been developed after consultation with a range of patients, their families and the doctors and therapists who form our Scientific Advisory Panel (the details of which can be viewed toward the end of this booklet). Whilst this guidance will focus on current UK practice, the issues which it highlights are relevant to many national contexts.

Key Messages

  • Early recognition of signs and symptoms of the acute brain injury is important as this potentially limits the extent of injury to the brain and enhances the chances of survival.
  • A full history of the illness from the patient and/or the family can assist the diagnosis and
    management of the causes and effects of an ABI.
  • Irrespective of the cause, these patients may be left with an ABI of various degrees.
  • Even in the case of mild brain injury, there can be an adverse impact on the person’s everyday functioning with a need for education and management.
  • ABI is not a singular diagnosis and presentations can be complex.
  • The effects of an ABI may become obvious after the patient is discharged home when they attempt more challenging tasks.
  • The effects of an ABI are seen not only immediately after the brain injury, but also in the long-term, and, in the case of children, later in life when they are using news skills.
  • Early referral to appropriate services for managing an ABI enhances recovery.
  • ABI impacts not only on the patient but also on the family members, friends, carers, and their
    wider communities.

This guide has been endorsed by:

A hard copy of the GP Guide is available from our office by calling +44(0)1653 692583 or via email

Management of Viral Encephalitis

Management of Suspected Viral Encephalitis. Professional Guidelines

In the 1980s the outcome of patients with herpes simplex virus (HSV) encephalitis was shown to be dramatically improved with aciclovir treatment. Delays in starting treatment, particularly beyond 48 hours after hospital admission, are associated with a worse prognosis. Several comprehensive reviews of the investigation and management of encephalitis have been published. However, their impact on day-to day clinical practice appears to be limited.

In February 2008 a group of clinicians met in Liverpool to begin the development process for clinical care guidelines based around a simple algorithm, supported by an evidence base, whose implementation is hoped would improve the management of patients with suspected encephalitis.

The scope of the guideline is to cover the initial management of all patients with suspected encephalitis, up to the point of diagnosis, in an acute care setting such as acute medical unit or emergency department. They are thus intended as a ready reference for clinicians encountering the more common causes of encephalitis, rather than specialists managing rarer causes. The guidelines also cover the specific treatments and further management of patients for whom a diagnosis of viral encephalitis is made, particularly that due to HSV, varicella zoster virus (VZV) and enteroviruses.

At the end of the guidelines the special circumstances of returned travellers, immunocompromised patients and antibody-associated encephalitis are discussed.

Many patients with suspected viral encephalitis ultimately prove to have another infectious or non-infectious cause for their illness. The further management and treatment of such patients is beyond the scope of this guideline, but the authors have included a section on follow-up and support for encephalitis patients in both the healthcare and voluntary sectors after discharge from hospital.

 

Page Created: 27 November 2023
Last Modified: 10 January 2024
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