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Encephalopathy, the clinical finding of an altered state of consciousness with some or all of headache, neurological signs and fever, presents a difficult diagnostic challenge for physicians. The number of infectious and noninfectious conditions that can present with encephalopathy, with or without cerebrospinal fluid (CSF) pleocytosis, is long and complex. A systematic approach to these patients is required in order to optimize the probability of accurately determining the etiological cause of the illness and to ensure that early specific therapy is initiated. The background paper written by Ford-Jones and colleagues and reviewed by the Canadian Paediatric Society (CPS) Infectious Diseases and Immunization Committee (pages 33–41) reviews the differential diagnosis, course of investigation and current understanding of acute demyelinating encephalomyelitis, and presents the crucial therapeutic alternatives in the management of childhood encephalitis.
The Infectious Diseases and Immunization Committee of the CPS recommends the following.
INFECTIOUS DISEASES AND IMMUNIZATION COMMITTEE
Members: Drs Gilles Delage, Directeur scientifique, Laboratoire de santé publique du Québec, Ste-Anne-de-Bellevue, Québec (chair); François Boucher, Département de pédiatrie, Centre Hospitalier Universitaire de Québec, Québec, Québec; Joanne Embree, Winnipeg, Manitoba; Elizabeth Ford-Jones, Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario (principal author); David Speert, Division of Infectious and Immunological Diseases, University of British Columbia, Vancouver, British Columbia; Ben Tan, Division of Infectious Diseases, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan
Consultants: Drs Noni MacDonald, Division of Infectious Diseases, Children’s Hopsital of Eastern Ontario, Ottawa, Ontario; Victor Marchessault, Cumberland, Ontario
Liaisons: Drs Neal Halsey, Johns Hopkins University, Baltimore Maryland (American Academy of Pediatrics); Susan King, Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario (Canadian Paediatric AIDS Research Group); David Scheifele, Division of Infectious Diseases, BC’s Children’s Hospital, Vancouver, British Columbia (Centre for Vaccine Evaluation); Ms Susan Tamblyn, Perth District Health Unit, Stratford, Ontario (Public Health); Dr John Waters, Provincial Health Officer, Alberta Health, Edmonton, Alberta (Epidemiology)
The recommendations in this Practice Guideline do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.