Neuropsychiatric sequelae in sporadic viral encephalitis.

Abstract

Background: Though sporadic cases of viral encephalitis are not uncommon in our country, there is a lack of prospective studies on the course and outcome of its neuropsychiatric complications.

Aim: To study the neuropsychiatric sequelae in patients with sporadic viral encephalitis.

Materials and methods: A prospective longitudinal study evaluated 34 consecutive cases of presumed viral encephalitis hospitalized during 1 year. A physician and a psychiatrist examined patients during recruitment and as and when necessary after that. Details of clinical presentation, investigation results, functional outcomes, and neurological and psychiatric sequelae at the time of discharge and follow-up were noted.

Results: Patients with viral encephalitis presented with varied clinical presentation. Out of 34 patients, 11 (32.5%) died during hospitalization. After recovery from acute illness, 18 (52.94%) patients had moderate functional disability, while five (14.71%) had good functional recovery. Among survivors, a high proportion of neuropsychiatric sequelae were observed even after recovery from the acute phase. Neurological sequelae were seen in 12 (35.29%) patients, which included extrapyramidal symptoms, seizures, hemiparesis, diabetes insipidus, deafness, truncal ataxia, and lateral rectus palsy. In comparison, psychiatric sequelae were seen in 15 (44.12%) patients and included organic amnesic syndrome, anxiety, depression, heaviness of the head, frontal headache, aggression, and emotional lability. All of these sequelae improved over 6 months of follow-up.

Conclusion: There is a high rate of neuropsychiatric sequelae in survivors of acute viral encephalitis, but most of these improve over some time with or without treatment. The high rates of psychiatric sequelae in an already difficult-to-diagnose condition such as encephalitis make it very prone to diagnostic dilemmas, resulting in delayed management. It is essential to be vigilant for these sequelae and their prompt management by improving liaison with a psychiatrist.