| Abstract | Encefalitis je jedna od najrelevantnijih neuropatologija koja uzrokuje visok morbiditet i mortalitet diljem svijeta. Radi se o upali moždanog parenhima koja dovodi do neuroloških promjena. Trenutno se učestalost encefalitisa kreće između 7 i 15 slučajeva na 100 000 stanovnika ovisno o zemlji. Encefalitis može utjecati na pojedince svih dobi, ali se često opaža u pedijatrijskoj i starijoj populaciji. Neki od mogućih uzročnika encefalitisa su: arbovirusi, enterovirusi, herpes simpleks virus, varicella-zoster virus, virus zaušnjaka, adenovirusi i citomegalovirus. Osim virusa, uzročnici mogu biti i drugi mikroorganizmi. Encefalitis može biti i zarazan, nastati kao posljedica izravne invazije patogena u mozak, najčešće sive tvari, i imunološki posredovan, uzrokovan imunološki posredovanim oštećenjem (obično bijele tvari). Unutar zarazne skupine, i neurotropni i ne-neurotropni (slučajni) patogeni mogu uzrokovati encefalitis. Ključ za rano prepoznavanje i liječenje je poznavanje sindroma encefalitisa, koji uključuje promijenjen mentalni status (obično više od 24 sata), popraćen dokazima upale moždanog parenhima. Ozbiljnost manifestacija uvelike varira od blage febrilne bolesti povezane s glavoboljom do ozbiljnog poremećaja s konvulzijama, komom, neurološkim poremećajima i smrću. Od dijagnostičkih postupaka važno je istaknuti lumbalnu punkciju. Za većinu encefalitisa, osim herpesvirusnog nema specifičnog liječenja. Kada se sumnja na virusni encefalitis, prve mjere uključuju potporno liječenje i korekciju bilo kakvog poremećaja elektrolita, autonomne disregulacije te bubrežne i jetrene disfunkcije. Također, važno je liječiti napadaje i nekonvulzivni epileptični status. Virusna infekcija mozga može izazvati trajna neurološka oštećenja, koja su češća nakon virusnog encefalitisa. Bez obzira na etiologiju, većina preživjelih pati od dugotrajnih posljedica nekog oblika. Ključ pozitivnog ishoda je pravovremeno prepoznavanje simptoma encefalitisa, što je jedna od glavnih zadaća visoko educirane medicinske sestre. U radu je detaljno opisan prikaz slučaja mlade djevojke koji je uspoređen s još tri različite kliničke slike encefalitisa. |
| Abstract (english) | Encephalitis is one of the most relevant neuropathologies that causes high morbidity and mortality worldwide. It is an inflammation of the brain parenchyma that leads to neurological changes. Currently, the incidence of encephalitis ranges between 7 and 15 cases per 100,000 inhabitants, depending on the country. Encephalitis can affect individuals of all ages, but is often seen in the pediatric and elderly population. Some of the possible causes of encephalitis are: arboviruses, enteroviruses, herpes simplex virus, varicella-zoster virus, mumps virus, adenoviruses and cytomegalovirus. In addition to viruses, the causative agents can also be other microorganisms. Encephalitis can be both infectious, caused as a result of a direct invasion of the brain by pathogens, most commonly gray matter, and immune-mediated, caused by immune-mediated damage (usually white matter). Within the infectious group, both neurotropic and non-neurotropic (accidental) pathogens can cause encephalitis. The key to early recognition and treatment is knowledge of the encephalitis syndrome, which includes altered mental status (usually more then 24 hours) accompanied by evidence of brain parenchymal inflammation. The severity of the manifestations varies greatly from a mild febrile illness associated with headache to a severe disorder with convulsions, coma, neurological disturbances and death. Among the diagnostic procedures, it is important to emphasize the lumbar puncture. There is no specific treatment for most encephalitis, except for herpesvirus. When viral encephalitis is suspected, initial measures include supportive care and correction of any electrolyte disturbances, autonomic dysregulation, and renal and hepatic dysfunction. It is also important to treat seizures and non-convulsive status epilepticus. Viral infection of the brain can cause permanent neurological damage, which is more common after viral encephalitis. Regardless of etiology, most survivors suffer long-term consequences of some form. The key to a positive outcome is a timely recognition of encephalitis symptoms, which is one of the main tasks of a highly educated nurse. The paper describes in detail the case of a young girl, which was compared with three other different clinical pictures of encephalitis. |
