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Encephalitis is a distressing illness for patients and their families. The onset often is acute, symptoms may progress rapidly, and previously healthy children become debilitated. In addition, even experienced physicians often are uncertain about the cause, appropriate therapy, and prognosis. A thorough and accurate review is difficult because the syndrome is complex and the number of etiologic agents and mimics of encephalitis are vast. Unfortunately, current knowledge of encephalitis is based largely on case reports and small series; high-quality evidence-based data are limited. Most important, the majority of cases have an unknown cause, which makes generalizations about encephalitis inherently problematic. This article focuses on encephalitis in immunocompetent children beyond the neonatal age group.

The first challenge in discussing encephalitis is to develop practical definitions. When brain tissue is available from biopsy or autopsy, inflammatory cell infiltrate of the brain defines encephalitis....

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