Most people with viral encephalitis have mild flu-like symptoms, such as:
- Aches in muscles or joints
- Fatigue or weakness
Sometimes the signs and symptoms are more severe, and might include:
- Confusion, agitation or hallucinations
- Loss of sensation or paralysis in certain areas of the face or body
- Muscle weakness
- Problems with speech or hearing
- Loss of consciousness
In infants and young children, signs and symptoms might also include:
- Bulging in the soft spots (fontanels) of an infant's skull
- Nausea and vomiting
- Body stiffness
- Poor feeding or not waking for a feeding
When to see a doctor
Get immediate care if you are experiencing any of the more-severe symptoms associated with encephalitis. Severe headache, fever and altered consciousness require urgent care.
Infants and young children with any signs or symptoms of encephalitis should receive urgent care.
The exact cause of encephalitis is often unknown. But when a cause is known, the most common is a viral infection. Bacterial infections and noninfectious inflammatory conditions also can cause encephalitis.
There are two main types of encephalitis:
- Primary encephalitis. This condition occurs when a virus or other agent directly infects the brain. The infection may be concentrated in one area or widespread. A primary infection may be a reactivation of a virus that had been inactive after a previous illness.
- Secondary encephalitis. This condition results from a faulty immune system reaction to an infection elsewhere in the body. Instead of attacking only the cells causing the infection, the immune system also mistakenly attacks healthy cells in the brain. Also known as post-infection encephalitis, secondary encephalitis often occurs two to three weeks after the initial infection.
Common viral causes
The viruses that can cause encephalitis include:
- Herpes simplex virus (HSV). Both HSV type 1 — associated with cold sores and fever blisters around your mouth — and HSV type 2 — associated with genital herpes — can cause encephalitis. Encephalitis caused by HSV type 1 is rare but can result in significant brain damage or death.
- Other herpes viruses. These include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.
- Enteroviruses. These viruses include the poliovirus and the coxsackievirus, which usually cause an illness with flu-like symptoms, eye inflammation and abdominal pain.
- Mosquito-borne viruses. These viruses can cause infections such as West Nile, La Crosse, St. Louis, western equine and eastern equine encephalitis. Symptoms of an infection might appear within a few days to a couple of weeks after exposure to a mosquito-borne virus.
- Tick-borne viruses. The Powassan virus is carried by ticks and causes encephalitis in the Midwestern United States. Symptoms usually appear about a week after a bite from an infected tick.
- Rabies virus. Infection with the rabies virus, which is usually transmitted by a bite from an infected animal, causes a rapid progression to encephalitis once symptoms begin. Rabies is a rare cause of encephalitis in the United States.
- Childhood infections. Common childhood infections — such as measles (rubeola), mumps and German measles (rubella) — used to be fairly common causes of secondary encephalitis. These causes are now rare in the United States due to the availability of vaccinations for these diseases.
Anyone can develop encephalitis. Factors that may increase the risk include:
- Age. Some types of encephalitis are more common or more severe in certain age groups. In general, young children and older adults are at greater risk of most types of viral encephalitis.
- Weakened immune system. People who have HIV/AIDS, take immune-suppressing drugs or have another condition causing a weakened immune system are at increased risk of encephalitis.
- Geographical regions. Mosquito- or tick-borne viruses are common in particular geographical regions.
- Season of the year. Mosquito- and tick-borne diseases tend to be more common in summer in many areas of the United States.
The complications of encephalitis vary, depending on factors such as:
- Your age
- The cause of your infection
- The severity of your initial illness
- The time from disease onset to treatment
People with relatively mild illness usually recover within a few weeks with no long-term complications.
Complications of severe illness
Inflammation can injure the brain, possibly resulting in coma or death.
Other complications — varying greatly in severity — may persist for months or be permanent. These complications can include:
- Persistent fatigue
- Weakness or lack of muscle coordination
- Personality changes
- Memory problems
- Hearing or vision defects
- Speech impairments
June 13, 2017
- Bennett JE, et al. Encephalitis. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed Jan. 24, 2017.
- Hardarson HS. Acute viral encephalitis in children: Clinical manifestations and diagnosis. http://www.uptodate.com/home. Accessed Jan. 31, 2017.
- Ferri FF. Encephalitis, acute viral. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. http://www.clinicalkey.com. Accessed Jan. 24, 2017.
- AskMayoExpert. Viral encephalitis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
- Gluckman SJ. Viral encephalitis in adults. http://www.uptodate.com/home. Accessed Jan. 24, 2017.
- Meningitis and encephalitis fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Meningitis-and-Encephalitis-Fact-Sheet. Accessed Feb. 1, 2017.
- Dorsett M, et al. Diagnosis and treatment of central nervous system infections in the emergency department. Emergency Medical Clinics of North America. 2016;34:917.
- Patel H, et al. Long-term sequelae of West Nile virus-related illness: A systematic review. The Lancet Infections Diseases. 2015;15:951.
- Hardarson HS. Acute viral encephalitis in children: Treatment and prevention. http://www.uptodate.com/home. Accessed Jan. 31, 2017.
- Daroff RB, et al. Viral encephalitis and meningitis. In: Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed Feb. 1, 2017.
- Zachary KC. Acyclovir: An overview. http://www.uptodate.com/home. Accessed Feb. 1, 2017.
- Breisch N. Prevention of arthropod and insect bites: Repellents and other measures. http://www.uptodate.com/home. Accessed Jan. 31, 2017.
- West Nile virus FAQ: Insect repellant use and safety. Centers for Disease Control and Prevention. http://www.cdc.gov/westnile/faq/repellent.html. Accessed Feb. 1, 2017.
- West Nile virus: Prevention & control. Centers for Disease Control and Prevention. http://www.cdc.gov/westnile/prevention/index.html. Accessed Feb. 1, 2017.
- Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Jan. 24, 2017.
- Howe CL, et al. Neuroprotection mediated by inhibition of calpain during acute viral encephalitis. Scientific Reports. 2016;6:28699.
- Singh TD, et al. Predictors of outcome in HSV encephalitis. Journal of Neurology. 2016;263:277.
- Wormser GP, et al. Update and commentary on four emerging tick-borne infections. Infectious Disease Clinics of North America. 2015;29:371.