Medical Question: Brain Infections

By Jordyn Redwood

Jordyn's Website
We're finishing up with Dale's questions. He asks: I have a character who is overcome by huge amounts of stress, and ends up in a coma for three days. The character suffers from Viral Encephalitis which is brought on from huge amounts of stress, and I only have a little bit of info about this. I got the idea from a real life FBI profiler who went through this. But he only went into a few paragraphs of what it was like. So I was wondering if you had any info about how someone would be cared for in this condition from the time of admittance, to the time of release?


To start, let's deal with what is viral encephalitis. Encephalitis is inflammation of the brain and/or spinal cord. Viral encephalitis means the inflammation is caused by a virus. When this type of patient presents to the ER, it may be hard to differentiate between encephalitis and meningitis. The meninges are composed of three membranes that cover your brain and spinal cord. The three membranes are: the pia mater, arachnoid mater, and dura mater. Symptoms of both encephalitis and meningitis can be fever, photophobia (sensitivity to light), headache, stiff neck, pain upon moving the neck, nausea and vomiting, and seizures. There are other symptoms as well. This is the short list.

One thing that struck me about Dale's question is the stress aspect and why it made this FBI agent vulnerable. Stress weakens your immune system but wouldn't be the cause of the encephalitis. There needs to be a causative agent (like a virus or bacteria) but he was likely set up to be more vulnerable by the stress he was under.

In the ER we'll draw blood to look at what the patient's white count and inflammatory makers are. He may get a CT or MRI of the head. We absolutely will have to get a sample of spinal fluid through a lumbar puncture. Typically we have to collect a culture sample of the cerebrospinal fluid before we give any antibiotics or antiviral therapy. Depending on the patient's condition, it would be determined if they need admission onto a regular floor or the ICU.

Here's a good reference if you're interested in more information about encephalitis:
http://www.ehealthmd.com/library/encephalitis/ENC_whatis.html