Encephalitis lethargica


Encephalitis lethargica

Description, Causes and Risk Factors:

A unique encephalitis, presumably viral in origin, which followed the influenza pandemic of 1914-1918. Symptoms included ophthalmoplegia and marked somnolence, and in many survivors, the delayed development of Parkinson disease; the basis for postencephalitic Parkinsonism.

The disease is an inflammation of the central nervous system, especially of the basal ganglia, the mid-brain -- chiefly the oculomotor nuclei and substantia nigra and the pons and medulla. However, no part of the nervous system is exempt. No disease except syphilis is so promiscuous in its cerebral localization.

Encephalitis lethargica

The cause of encephalitis lethargica is not known for certain. Research in 2004 suggested that the disease is due to an Immune reaction. In this study, many of the people with encephalitis lethargica had experienced recent pharyngitis and the authors found some evidence linking the reaction to prior Streptococcal throat. They hypothesized that encephalitis lethargica is mediated by variations of the post-Streptococcal immune response.

There is also some evidence of an autoimmune origin with antibodies (IgG) from patients with encephalitis lethargica binding to neurons in the basal ganglia and mid-brain. Western immunoblotting showed that 95% of encephalitis lethargica patients had auto-antibodies reactive against human basal ganglia antigens. By contrast, antibodies reactive against the basal ganglia were found in only 2-4% of child and adult controls.

Some researchers believe that new data supports the influenza hypothesis, while others consider this less likely.

Symptoms:

Symptoms include:

    High fever.

  • Sore throat.

  • Headache.

  • Sleep inversion.

  • Catatonia.

  • Abnormal eye movement.

  • Upper body weakness.

  • Muscular pain.

  • Tremors.

  • Neck rigidity.

  • Behavioral changes and psychosis.

  • Parkinsonism.

Diagnosis:

The most useful diagnostic sign is swollen cervical glands. This indicates the presence of the parasite. Populations can be screened for clinical signs of the disease (the early phase symptoms) and the use of tests that detect antibodies to the parasite in the blood. An early diagnostic sign of the bite of the tsetse fly is the appearance of a painful red sore (chancre) at the site of the bite.

A type of diagnosis called phase diagnosis can be used to help determine the level of advancement of the disease. Cerebrospinal fluid (CSF) is obtained by the technique of lumbar puncture and analyzed. Phase diagnosis requires medical and laboratory staff, and is typically done in a Clinic. The long period, symptom-free period of a Trypanosoma brucei gambiense infection can complicate and delay diagnosis.

Imaging: X-ray, MRI and CT scans, and electromyography.

Treatment:

The course of encephalitis lethargica varies, depending upon complications or accompanying disorders. Treatment for encephalitis lethargica is based on the symptoms a person experiences. Levodopa and other anti-Parkinson drugs often produce dramatic responses in people with this condition.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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