2. Introduction
Encephalitis is an acute inflammation of the
parenchyma of brain & spinal cord
Encephalitis with meningitis is known as
meningoencephalitis
Dr. L. Surbala (MPT Neurology)2
3. Epidemiology
A rare disease occurring in approximately 0.5 per
100,000 individuals
Most common in children, elderly, and people with
weakened immune systems (HIV/AIDS or cancer).
Dr. L. Surbala (MPT Neurology)3
4. Pathology
Virus enters blood & reaches the parenchyma of
brain, cortex, white matter, basal ganglia & brainstem
Inclusion bodies are often present in neurons & glial cells &
there is infiltration of polymorphonuclear cells in
perivascular space
There is neuronal degeneration & diffuse glial proliferation
often associated with cerebral edema & increased ICP
Thrombosis may occur in small arteries of brain
Tonsilar herniation may also be seen due to raised ICP
Dr. L. Surbala (MPT Neurology)4
5. Signs & symptoms
Symptoms in milder cases of encephalitis usually include:
fever
headache
poor appetite
weakness
a general sick feeling
In infants, important signs include:
vomiting
a full or bulging fontanel
crying that doesn't stop or that seems worse when an infant is picked up
or handled in some way
body stiffness
Dr. L. Surbala (MPT Neurology)5
6. In more severe cases
of encephalitis,
high fever
severe headache
nausea and vomiting
stiff neck
confusion
disorientation
personality changes
convulsions (seizures)
problems with speech or
hearing
hallucinations
memory loss
drowsiness
coma
Dr. L. Surbala (MPT Neurology)6
7. Encephalitis can follow or accompany common viral
illnesses,
There are sometimes signs & symptoms of these
illnesses beforehand
But often, encephalitis appears without warning.
Dr. L. Surbala (MPT Neurology)7
8. Contagiousness
Brain inflammation itself is not contagious,
Any viruses that cause encephalitis can be
infectious
Dr. L. Surbala (MPT Neurology)8
10. Viral enchephalitis
Viral encephalitis can be due to direct effects of acute
infection, or as sequelae of a latent infection.
A common cause of encephalitis in humans is herpes simplex
virus type I (HSE)
Others include infection by
Flaviviruses such as St. Louis encephalitis or West Nile virus, or
Togaviruses such as Eastern equine encephalitis (EEE), Western
equine encephalitis (WEE)
Venezualen equine encephalitis (VEE).
Dr. L. Surbala (MPT Neurology)10
11. Herpesviral encephalitis
Herpes simplex encephalitis (HSE) is a severe viral infection of
the human CNS
It is estimated to affect at least 1 in 500,000 individuals per
year.
About 1 in 3 cases of HSE result from primary HSV-1 infection,
predominantly occurring in individuals under age of 18;
2 in 3 cases occur in seropositive persons,
few of whom have history of recurrent orofacial herpes
Approximately 50% of individuals that develop HSE are over 50
years of ageDr. L. Surbala (MPT Neurology)11
12. Bacterial & others
It can be caused by a bacterial infection, such as
bacterial meningitis, spreading directly to brain
(primary encephalitis), or may be a complication of a
current infectious disease syphilis (secondary
encephalitis)
Certain parasitic or protozoal infestations, such as
toxoplasmosis, malaria, or primary amoebic
meningoencephalitis, can also cause encephalitis in
people with compromised immune systemsDr. L. Surbala (MPT Neurology)12
13. Limbic encephalitis
Pathogens responsible for encephalitis attack primarily limbic
system, often causing memory deficits
However, for 20% of people with the diagnosis of limbic
encephalitis an MRI will not show any neurological abnormalities
60% of the time, limbic encephalitis is paraneoplastic in origin.
A severe form of limbic encephalitis caused by neoplasms most
commonly associated with small cell lung carcinoma
Whereas majority of encephalitides are viral in nature, PLE is
often associated with cancer
Dr. L. Surbala (MPT Neurology)13
14. Encephalitis lethargica
It is an atypical form of encephalitis which caused an epidemic
from 1918 to 1930.
Those who survived sank into a semi-conscious state that lasted
for decades until L-DOPA was used to revive those still alive in
the late 1960
The cause is now thought to be either a bacterial agent or an
autoimmune response following infection.
Also known as "sleepy sickness" or as "sleeping sickness"
The disease attacks the brain, leaving some victims in a statue-like
condition, speechless and motionlessDr. L. Surbala (MPT Neurology)14
15. Duration & prognosis
For most forms of encephalitis, acute phase of illness (when
symptoms are most severe) usually lasts up to a week
Full recovery can take much longer, often several weeks or
months.
Without treatment, HSE results in rapid death in
approximately 70% of cases
HSE is fatal in around 20% of cases treated, and causes
serious long-term neurological damage in over half of survivors
Dr. L. Surbala (MPT Neurology)15
16. Diagnosis
Neurological examinations reveal a drowsy or confused patient
Stiff neck, may indicate meningoncephalitis
CSF : varies from normal to increased amounts of protein & WBC with
normal glucose
EEG may show sharp waves in one or both of temporal lobes.
CT scan examination to exclude brain swelling before Lumbar puncture
Diagnosis is made with detection of antibodies in CSF against a
specific viral agent (such as herpes simplex virus) or by polymerase
chain reaction that amplifies RNA or DNA of virus responsible (such
as varicella zoster virus).
Dr. L. Surbala (MPT Neurology)16
17. Prevention
Encephalitis cannot be prevented except to try to prevent
causes that may lead to it
Encephalitis that may be seen with common childhood illness can
be largely prevented through proper immunization
Children should avoid contact with anyone who already has
encephalitis.
Dr. L. Surbala (MPT Neurology)17
19. PT assessment
Presenting complains: Headache, nausea, vomiting, fever,
convulsions, confusion, abnormal movements
History: preceding infection, general weakness, frequent headache
Vitals: BP, PR, RR, Temperature abnormalities may be noted
Observation:
Posture; abnormal posturing
Gait: abnormalities (may be ataxic)
Limb attitude: abnormal attitude (synergies)
Abnormal Respiratory patternDr. L. Surbala (MPT Neurology)19
20. Higher function:
Level of consciousness: altered sensorium
Orientation: confusion
Memory: affected
Speech: dysarthria , aphasia, mutism
Cranial nerve assessment: features of lower cranial
nerve palsy will be seen
Sensory system: impaired
Tonal abnormalities will be seen
Reflexes: exaggerated DTR, positive
barbinski’s, presence of abnormal lower level reflexes
(primitive reflexes)
Dr. L. Surbala (MPT Neurology)20
21. ROM: decreased range & flexibility
Strength: decreased
Chest examination & Respiratory assessment:
accumulation of secretions, decreased chest
expansion or abnormal respiratory pattern may be
seen
Gustatory examination: swallowing & speech
difficulty
Dr. L. Surbala (MPT Neurology)21
22. Bladder & bowel involvement
Functional disability
Special test: kernig, brudjinski shows positive
response
Investigations: blood & CSF examination, CT
or MRI, gram stain, serology shows abnormal
findings
Problem listing
Dr. L. Surbala (MPT Neurology)22
23. PT aims
Psychological support
Prevent chest complications
Prevent DVT
Prevent bed sores
Correct deformity
Promote vital function
Normalize tone
Normalise postural reflexes
Promote integration of sensory input
Promote voluntary movement pattern
Improve overall functionDr. L. Surbala (MPT Neurology)23
24. Psychological support
Maintain a non threatening positive attitude
Good support
Gain confidence of the patient
Counseling of family members & patient
Give information as necessary only
Dr. L. Surbala (MPT Neurology)24
25. Prevent chest complications
Breathing exercise, postural drainage & suctioning as
required
Cervical & thoraxic mobility exercise
Thoraxic expansion exercise
Strengthening of respiratory muscles
Dr. L. Surbala (MPT Neurology)25
26. Prevent DVT
Active & passive ankle & toe exercise
Active limb exercise
Limb elevation
Early mobilization as soon as possible
Propped up position in bed & bed mobility exercise
Dr. L. Surbala (MPT Neurology)26
27. Prevent bed sores
Proper positioning with pads & cushions
Use of water bed or foam mattress
Regular inspection of the skin
Use cotton clothing to absorb sweat
Avoid dragging during transfer
Regular turning & changing position
Dr. L. Surbala (MPT Neurology)27
29. Promote vital function
Improve respiratory capacity with positioning & tech s/a
glossopharyngeal breathing exercise in respiratory
paralysis
Keeping the neck in slight flexion improves respiratory
capacity
Specific positioning increase air entry in targeted lobes
Massage & mechanical pressure provides reflex stimulus to
improve peristalsis (kneading/ stroking)
Facilitate swallowing with positioning, right selection of
food texture, oromotor stimulation
Maintaining cardio respiratory endurance with active
exercise of possible muscle work
Dr. L. Surbala (MPT Neurology)29
31. Promote integration of sensory
input
Stimulation by combined proprioceptive, visual &
auditory input
Cues & commands
Demonstration of activity
Sensory re education if necessary
Training in different environment
Dr. L. Surbala (MPT Neurology)31
32. Promote voluntary movement
pattern
Open kinematic chain exercise to improve mobility
Close kinematic chain exercise to improve stability
Transfer techniques
Including functional challenges
Problem solving task
Dr. L. Surbala (MPT Neurology)32
33. Improve overall function
Maintenance of physical activity
Maintenance of CV endurance
Early Return to activity or work
Dr. L. Surbala (MPT Neurology)33
