This disease was first registered and described in the early 20th century by Austrian neurologists, lethargic encephalitis had the character of an epidemic and covered entire countries. Since then, its causative agent has not been precisely known and has not been identified. Encephalitis lethargica is less common today, at least in its typical form. Nevertheless, doctors should be aware of its characteristic symptoms at different stages of the disease, since when it becomes chronic, the disease can cause severe neurological disorders up to death.
Why encephalitis lethargica occurs and how to recognize it
According to the assumptions of scientists, lethargic encephalitis is caused by a special virus, but the causative agent of this infectious disease today is so and not detected, although the disease itself has been known for more than a hundred years. Perhaps its elusiveness is explained by its rapid death in the external environment. However, lethargic encephalitis is transmitted by airborne droplets and contact, penetrating through the mucous membranes of the respiratory organs into the central nervous system and affecting it.
There are two main stages of the disease with lethargic encephalitis – as usual, it is acute and chronic forms. It is important that the transition from the acute stage to the chronic stage can last up to 10 years, although sometimes it takes several months. The acute stage of the disease is characterized by symptoms of severe inflammation, while the chronic stage is degenerative.
The main symptoms that manifest lethargic encephalitis
Acute form of lethargic encephalitis in its classical manifestation begins with a high rise in temperature and traditional signs of severe intoxication – headaches, feeling overwhelmed, vomiting, muscle pain and severe dizziness. The patient complains of severe salivation and hyperhidrosis, the skin sebaceous glands are hyperactive, and the patient's skin and hair look shiny.
The most characteristic signs by which it is easy to determine the acute stage of lethargic encephalitis are sleep disturbance and pathology of the oculomotor nerve. Sleep disturbance is manifested by the fact that the patient is pathologically drowsy, can fall asleep at any time and in the most inappropriate position, and if he is awakened, he will immediately fall asleep again. This sleep disturbance can last up to 3 weeks. Perhaps, on the contrary, a manifestation of pathological insomnia, when the patient cannot fall asleep at all. Sometimes the change of daytime and nighttime sleep can be perverted.
Ptosis, gaze paralysis, diplopia, abnormal pupillary response, and blurred vision may occur in patients with lethargic encephalitis.
In the acute stage of the disease, patients may experience a psychosensory disorder, auditory hallucinations may occur, and in severe cases, there may be a disorder of the respiratory rhythm and cardiovascular activity, threatening a fatal outcome.
Today, the symptoms of lethargic encephalitis are most often expressed atypically. The disease can be similar in its manifestations to an acute respiratory infection, against which sleep is briefly disturbed, muscle tics and episodes of diplopia occur. The acute phase of lethargic encephalitis can last for several days or several months. Residual effects can be manifested by sleep disturbances, headaches, depression, mild ptosis. In almost every third patient, it passes into the chronic stage of the disease.
The chronic stage of lethargic encephalitis is characterized by parkinsonism syndrome, endocrine disorders. The patient loses interest in the outside world, suffers from hyperkinesis, blepharospasm. Patients with lethargic encephalitis are characterized by greasy skin, hyperhidrosis.
Diagnostics and principles of treatment of encephalitis lethargica
Differential diagnosis of lethargic encephalitis, especially in its acute stage, should be carried out with serous meningitis. In the acute stage, antiviral agents, detoxification therapy, desensitizing drugs are prescribed, if necessary, according to indications, corticosteroids, psychotropic drugs are prescribed. There is currently no specialized treatment for encephalitis lethargica.
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