Some Observations in the Treatment of Acute Encephalitis by Roentgen Therapy and Typhoid Shock Reactions
Since the great pandemic of influenza from 1916 to 1920, renewed interest has been shown in the diagnosis and treatment of acute and chronic encephalitis. As experience has increased in the management of this condition we have found that a great many cases do not conform to the classical symptomatology that was first described by von Economo in 19171. While the severe, acute manifestations may consist of “somnolence, ophthalmoplegia and profound asthenia,” the onset in most of our cases has not been so typical.
For the sake of accuracy the lethargic type of encephalitis must be differentiated particularly from such conditions as benign lymphocytic choriomeningitis, disseminated encephalomyelitis, and acute multiple sclerosis. Of even greater importance is the necessity for the careful differential diagnosis of spontaneous subarachnoid or intracranial hemorrhage, subdural hematoma, brain tumor, brain abscess, atypical types of meningitis, or hysterical cataleptic states. Likewise, the cerebral manifestations of general disease may simulate acute encephalitis such as diabetic coma, uremia, metastatic brain lesions, or syphilis of the central nervous system. If a careful clinical and laboratory study is made in all cases, the lesion can usually be placed in its proper category.
At the Clinic, among the early acute cases of encephalitis, we have found that the most common symptoms are headache, somnolence, coma, oculomotor disturbances, nausea or vomiting, and fatigue. In certain cases we often find severe vertigo, disturbances of speech, convulsions, monoplegia or hemiplegia. Not infrequently our study of these patients must include not only the usual clinical or. . .