The Neuropsychiatric Consequences of Childhood Encephalitis: A Review of Cases from Middle-Eastern Countries

Encephalitis is an acute inflammation of the brain which can arise after infections such as septicemia or by primary extension of the inflammation in cases of cerebral abscess or meningitis. In a more restricted sense, it refers to a primary disease in which inflammation of the brain is caused by viral agents. Especially in children it may also arise via autoimmune or hypersensitivity reactions. Although, laboratory processes have sufficiently developed to isolate and demonstrate offending agents in most of the cases, a number of sporadic cases remain in which a viral etiology is suspected on account of general presentation. The symptoms of encephalitis include headache, fever, drowsiness tremors, vomiting and photophobia along with those arising from involvement of the central nervous system (Lishman, 2003; Maria & Bale JR, 2006). The principal feature of cerebral involvement is disturbance of consciousness. Delirium may figure prominently in some varieties. Seizures are common especially in children and can be the presenting feature. Focal neurological signs depend on the site of inflammation and may vary. Changes in pupils and in deep tendon reflexes, ocular palsies, nystagmus, ataxia, pathological reflexes, and paresis of limbs are common. Dysphasia may denote involvement of the temporal lobe while urinary retention or paraparesis may reveal involvement of the spinal cord. Occasional cases may present with neuropsychiatric symptoms such as hallucinations, psychosis, changes in personality, dementia, delirium, delusions, affective changes, paraphilias, amnesia and parkinsonism. Those attracted attention in early epidemics of encephalitis lethargica and examples may still occur with other varieties (Lishman, 2003; Maria and Bale JR, 2006). Although encephalitis may be an important cause of delirium and dementia as well as other psychopathology in childhood, those diagnoses present a diagnostic challenge to most child and adolescent psychiatrists leading to missed diagnoses (Cepeda, 2000; Jha, 2004; Nunn, Williams & Ouvrier, 2002, Schieveld et al., 2007). Also, encephalitis may be associated with significant childhood morbidity and mortality worldwide, however not much is known about the contemporary epidemiology and outcome (Galanakis et al., 2009).