Transcription:
Encephalitis

Melanie Cole: Welcome to Back To Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And today, we're talking about encephalitis, symptoms, causes and treatments available at Weill Cornell Medicine. Joining me is Dr. Hai Hoang. He's an Assistant Professor of Clinical Neurology at Weill Cornell Medicine. Dr. Hoang, it's a pleasure to have you join us today. I'd like you to just start by telling the listeners what is encephalitis.

Dr. Hai Hoang: Thank you. Yes. So I think the simplest way to explain encephalitis is it's essentially inflammation of the brain and I'll kind of just leave it as that, because it's just inflammation.

Melanie Cole: So people don't think of the brain is getting inflamed. We think of muscles or joints or things like that. So tell us what symptoms somebody might notice that would signal this kind of thing.

Dr. Hai Hoang: So when I think of somebody who may have encephalitis, I think of somebody who has neurologic and psychiatric symptoms. So neurologic, I mean like headaches, seizures, vision changes weakness, numbness, confusion, difficulty with their speech and swallowing. It could almost be any type of neurologic symptom. And then I would expect that they have the combination of psychiatric symptoms. So that's severe depression, mania, paranoia, delusions, and hallucinations. And I think I wanted to kind of preface that it's not just having these two types of symptoms, but really there's more nuanced features like how long these symptoms have been going on for? What other medical problems does the patient have? And kind of all together, that's what makes me think about encephalitis.

Melanie Cole: Wow. Okay. So you've given us some examples of the types of symptoms. Do we know why this happens? How do you contract encephalitis? Are there viruses that cause it? Tell us a little bit about that Dr. Hoang.

Dr. Hai Hoang: So there are multiple causes for encephalitis, because there's many things that can cause inflammation. But as a neurologist, I have to be thinking about two types because they're the majority and that's infectious causes and autoimmune causes. So when I think of infectious, it's like bacteria, viruses, fungi, and they're all contracted in various ways. There's not one way that you can get infectious encephalitis. The main type of an infectious encephalitis that we have to be thinking about because it's treated in a unique way is a herpes encephalitis. With regards to the other big group, which is autoimmune, that just refers to your body attacking itself. And for the most part, you can't contract an autoimmune disease, like you can't catch it from the environment.

Melanie Cole: So are there risk factors in that case? Are people who suffer from autoimmune diseases, Crohn's, lupus, any of those things, are they more at risk? Or if somebody has herpes, now are they more at risk ? Or what if they have both? How do you assess risk?

Dr. Hai Hoang: Yeah. So that's kind of where the patient's past medical problems and active medical problems come into play. So if somebody has a history of autoimmune diseases or a history of just herpes infections, like cold sores or genital herpes, like that raises my red flag when they come in with neurologic and psychiatric symptoms. So absolutely, these things do come into play and patients with autoimmune and herpes infections do have a higher risk of getting encephalitis.

Melanie Cole: So is it sometimes fatal? We think of brain things and inflammations as being something really, really terrible. Is it most often treatable? Is it sometimes fatal? Tell us a little bit about that.

Dr. Hai Hoang: So, I think inflammation is a good and bad thing, like when you think of inflammation, if you have a bruise on your body, that swelling, that redness, that pain, that's all inflammation happening to heal your body. But at the same time, inflammation, yeah, it can be fatal if it gets out of hand. And so encephalitis can be fatal, especially if you're elderly and have other active medical problems. But actually, most patients can survive from the encephalitis.

Melanie Cole: Is it emergent that you treat it, Dr. Hoang? Are there long-term effects or complications if it's left too long untreated? Is this an emergent condition?

Dr. Hai Hoang: So herpes encephalitis is absolutely an emergent condition if there's a strong suspicion for it. We as neurologists, we actually empirically treat somebody for herpes infection even while we're running like the diagnostic test for it. And so, absolutely. And similarly with autoimmune encephalitis, we often give treatment before diagnostic testing if the suspicion is high enough, so yes.

Melanie Cole: Well, then let's talk about treatments. If you determine that someone has these risk factors or they had herpes, or some other reason that you determine that this is what's going on, tell us about treatments that might be available at Weill Cornell Medicine.

Dr. Hai Hoang: So at Weill Cornell, we actually have a pretty multidisciplinary approach to encephalitis because it involves not only neurologists, but rheumatologists, people who specialize in autoimmune diseases; oncologists, people who specialize in cancers, and infectious disease providers. And so we all kind of come together to kind of formulate a plan which may involve giving them antibiotics while we do the workup, which includes multiple testing, such as MRIs, EEGs, and lumbar punctures. And then during that workup, if we find malignancies, cause sometimes you can have a malignancy associated with encephalitis, that brings in the oncologist as well. And so the treatments overall depend on like the etiology. But we at Weill Cornell can treat all types of encephalitis from infectious to autoimmune and even ones that are related to malignancies.

Melanie Cole: Wow. So it's really a multidisciplinary approach. And how at Weill Cornell are you expediting that workup and getting everybody involved in a timely manner, because that really benefits the patients and for better outcomes, yes?

Dr. Hai Hoang: Yes, it does. And so, I actually am also a neurohospitalist. So I actually see these patients in the ER very often. And fortunately, we have a low threshold at Weill Cornell to admit patients with any concern for encephalitis, just because we know what the outcomes are. And so with that being said, the expedited workup happens pretty quickly, one, because I'm almost always involved with these patients, like from the ER presentation.

Melanie Cole: Wow. That's great that you're there as a hospitalist as well, because that helps to navigate the whole system, which can be confusing. So as we're talking about encephalitis, are there things that can trigger it because there is some literature about stress. Is that a myth or can stress trigger the reactions that then can trigger encephalitis?

Dr. Hai Hoang: I think stress is a really a catch all phrase. And I don't think I know of any one provider that will say stress doesn't contribute to a specific disease. But at the same time, I wouldn't say that, by reducing your stress, you can prevent yourself from getting an encephalitis. So what I'll comment on is stress reduction is always a good strategy for somebody's general wellbeing, but I would not say that if you reduce your stress, you will have a 0% chance of getting an encephalitis. It's just too simple of an explanation for a very complicated disease.

Melanie Cole: Well, it certainly is. And as you say, stress can affect so many of our physiological processes. So tell us a little bit about life after and I'd like you to wrap up with whether it can be prevented and your very best advice. But life after, if someone is diagnosed and you're treating them, is this something that then goes away? Are they at risk for it to happen again? What's life like for them?

Dr. Hai Hoang: So with regards to complications after a hospitalization. I think when it comes to herpes encephalitis, they tend to have a good overall outcome where they may have a little bit of cognitive deficits, like a little bit of short-term memory, a little bit of mood and behavior issues. But overall, they are able to still function in the real world. They can still hold a job. They have no trouble ambulating and walking by themselves And they do really well overall.

With regards to autoimmune encephalitis, I think that's a little bit trickier to say what their complications are after hospitalizations. They usually affect patients at a younger age. And so the younger patients actually bounce back pretty easily as well with less cognitive issues, less issues with walking, less risk of seizures. But the older population, like the 65 and up population, if they get an autoimmune encephalitis. They tend to have a lot of residual complications because even though we suppress the inflammation so that they're able to function. It's still an ongoing issue where they have ongoing inflammation that may need to be continually treated after leaving the hospitalization.

Melanie Cole: Do you have any final thoughts to leave patients with that are curious about encephalitis that are wondering about it and if it can be prevented?

Dr. Hai Hoang: Well, I think my final thought is that when you read about encephalitis online, it is very scary of a disease. And I think that really prompts our reaction to really investigate this comprehensively. The caveat is encephalitis in general, especially autoimmune, is actually a very new field within the last 10 to 15 years. And with that being said, there's a lot of new information coming out like month by month. And so we're still learning about this disease, but the prospects are really good.

Melanie Cole: Thank you so much, Dr. Hoang, for joining us today and sharing your expertise about something that not everybody knows about. So thank you again for educating us today. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That wraps up today's episode of Back To Health. We'd like to invite our audience to download, subscribe, rate and review Back To Health on Apple Podcasts, Spotify and Google Podcasts. And for more health tips, go to weillcornell.org and search podcasts. And parents, please don't forget to check out our Kids Health Cast. I'm Melanie Cole.

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