Encephalitis – Warning signs, Causation, Treatment & Support

Encephalitis is a serious, and sometimes life threatening or life changing, condition in which the brain becomes swollen.

There are up to 6,000 cases of encephalitis in the UK each year. Absolutely anyone can be affected by encephalitis but as is the case with many illnesses, the vulnerable such as the very young and the very old are at increased risk.

Unfortunately, if left undiagnosed or untreated, it can leave people with significant brain damage and even life-changing disabilities.

Encephalitis is a medical emergency and needs to be treated in hospital, where a variety of diagnostic tests can be done.

Tests used to diagnose encephalitis can include lumbar punctures (to remove a sample of spinal fluid to test), blood tests, and both CTG and MRI scans.

The earlier the treatment is started, the more successful it is likely to be. Delays in treatment can be fatal or lead to a more severe outcome.

The treatment offered will very much depend on the underlying cause of the encephalitis. However it is important that treatment is started promptly, and treatment may sometimes be started before a definite cause is found.

It is imperative that diagnostic tests are carried out at an early stage, as the results of these tests will inform the treatment plan.

Patients with viral types of encephalitis will receive antiviral medication such as Aciclovir – which is effective in patients with the herpes simplex virus – however, for many viruses there is no effective medication.

Patients with bacterial encephalitis will receive antibiotics, and patients with autoimmune encephalitis can be treated with steroids and plasma exchange treatment.

Depending on the nature and severity of the encephalitis secondary treatment such as painkillers to reduce discomfort or a high temperature, medicine to control seizures or fits, and oxygen to support with breathing may also be required.

Sometimes patients may be placed in an induced coma to effectively shut down the brain and allow it to recover from the swelling that the encephalitis has caused.

Encephalitis is often mild, but those with a severe illness can leave patients with more significant long-term after-effects including acquired brain injury.  The most severe form of encephalitis does have a high mortality rate (and has been shown to be as high as 30%) however a full recovery can be made.

The length of time that someone is in hospital can vary greatly and can be as little as a few days or as long as a number of months.

Recovery from encephalitis can be a very long and frustrating process. Sadly, many people do not make a full recovery and are left with long-term problems due to the damage that the encephalitis has caused to the brain.

Long-term complications can include: memory loss; frequent seizures or fits; personality or behavioural changes; sensory changes; problems with attention, concentration, planning and problem solving and persistent tiredness.

It is therefore really important that there is structured rehabilitation after encephalitis and access to appropriate rehabilitation can improve the long-term outcome.

Early diagnosis and treatment is crucial, so a delay in diagnosis or misdiagnosis can be as a result of negligence. Such delays can lead to a delay in treatment which could result in worsening of the condition or even death.

Encephalitis is often difficult to diagnose due to the fact that the presenting symptoms are often very similar to the symptoms of other conditions such as meningitis, stroke and brain tumours. The treatment for encephalitis is however very different, and encephalitis should not be ruled out until appropriate tests including scanning have been done.

Our specialist medical negligence team have experience with claims relating to delays in diagnosis and misdiagnosis of encephalitis.

In order to be successful in such a claim we must firstly show that there has been a breach of duty i.e. that the care afforded to the patient fell below the standard to be expected from competent practitioners.

Examples of breaches of duty could include (but not be limited to):

• a GP failing to refer a patient to hospital when presenting with symptoms that could be indicative of encephalitis;
• a doctor attributing a patient’s erratic behaviour to drug use and not considering encephalitis;
• a failure on the part of a clinician in A&E to appropriately triage a patient presenting with symptoms of encephalitis;
• a failure, on admission, to carry out appropriate diagnostic tests such as a lumbar puncture.

As well as showing that there has been a breach of duty we must also show that the condition resulted from, or was made worse, by any substandard treatment. This is known as causation.

Whilst the majority of encephalitis claims relate to a delay in diagnosis or misdiagnosis we have also successfully acted for clients in relation to negligent nursing and medical care provided to them whilst they were in hospital with encephalitis.

Those suffering from infectious encephalitis initially experience flu like symptoms such as a high temperature or headache. More serious symptoms can manifest hours, days or even weeks after the first symptoms appear.

Later symptoms can include; photophobia (an aversion to bright lights), sensory changes, neck stiffness, confusion, disorientation and unusual behaviour. The nature and severity of the symptoms can vary considerably between patients. For example, one patient could experience mild drowsiness whereas another person could become unconscious.

Those suffering from autoimmune encephalitis will experience similar symptoms but there will be a much more gradual onset of symptoms as this type of encephalitis takes longer to progress. Early symptoms can include problems with sleeping, memory loss and hallucinations.