Key messages

• The acute encephalitis syndrome features a triad of fever and head pain, and acute neurological dysfunction.

• Herpes simplex encephalitis is the most common form of lethal non-epidemic encephalitis. Morbidity and mortality are high. Pharmacotherapy is available, but is only effective if begun promptly.

• Parasitic infections remain important treatable causes of acute encephalitis in the developing world. Central nervous system toxoplasmosis is common in the immunosuppressed.

• Epidemic arboviral and rabies encephalitis remain important causes of morbidity and mortality worldwide. Management is limited to supportive care.

• Mechanisms of secondary brain injury superimpose hyoxia-ischemia on the primary infectious-inflammatory process.

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