Dale Asks:

I have a character who 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. 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?

Jordyn Says:

To start, let’s deal with what viral encephalitis is. Encephalitis is inflammation of the brain and/or spinal cord. Viral encephalitis means the infection is caused by a virus. When this type of patient presents to the ER, it may be hard to differentiate between encephalitis and meningitis. 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 your 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 see if the patient’s white count and inflammatory markers are elevated. He may get a CT of the head. We absolutely will have to get a sample of spinal fluid through a lumbar puncture. Typically we have to collect a sample of the cerebrospinal fluid for testing 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.

If the cause of the brain infection is of a viral nature, the medical team will likely give symptomatic support as antibiotics are ineffective against viruses. There are anti-viral agents available, but this is up to the discretion of the medical team as to whether or not their use would be beneficial for the patient.

Symptomatic support in this case would be keeping the patient hydrated, controlling pain, and frequent reassessment of his neurological status.

For more information on encephalitis check out these articles here and here.