This document discusses encephalitis, an inflammation of the brain tissue that is most commonly caused by viruses. It can also be caused by bacteria or fungi. The document defines encephalitis and provides details on types (primary, secondary), causes (infectious like arboviruses or non-infectious), clinical manifestations such as fever and headaches, diagnostic tests, complications, treatment including antiviral medications, and nursing management which involves monitoring for fever and maintaining fluid balance.

1. Prof.Kavitha.P, M.Sc (N)
Vice Principal,
Ganga College of Nursing ,
Coimbatore.

2. SUBJECT:
MEDICAL SURGICAL NURSING-II
UNIT NO:3
NURSING MANAGEMENT OF PATIENT WITH
NEUROLOGICAL DISORDERS
TOPIC:
ENCEPHALITIS

3. SUBJECT:
MEDICAL SURGICAL NURSING-II
UNIT NO:3
NURSING MANAGEMENT OF PATIENT WITH
NEUROLOGICAL DISORDERS
TOPIC:
ENCEPHALITIS

4. INTRODUCTION
 Brain tissue infection
 Can be accompanied with meningitis
 Meningo encephalitis is most common.
 It can be acute, sub acute and chronic
 50%is an opportunistic infection

5. OBJECTIVES
At the end of the class, the students are able to
 review anatomy and physiology of brain layers and
tissues
 define encephalitis
 state the incidence of encephalitis
 enlist the causes and risk factors of encephalitis
 explain the types of encephalitis
 narrate the pathophysiology of encephalitis
 state the clinical manifestations of encephalitis
 discuss the diagnostic measures of encephalitis
 State the complications of encephalitis
 enumerate the management of patient with
encephalitis
 explain the nursing management of patient with
encephalitis

7. DEFINITION
Encephalitis is an inflammation of the brain tissue,
that is caused by virus less commonly by bacteria
and fungi.
Inflammation of brain
Dysfunction of brain

8. ENCEPHALOPATHY
It describes a clinical syndrome of altered
mental status manifesting as reduced
consciousness or altered behaviour.

9. INCIDENCE

10. CAUSES
unknown Infectious
Non
infectious

11. INFECTIOUS
Arbo
Virus
VARICELL
A ZOSTER
MOSQUITO
BORN
VIRUS
EBSTEIN
BARR
HSV-1,2

12. NON INFECTIOUS
Acute disseminated
encephalomyelitis
Antibody associated
Encephalitis
Allergy-Post infection Heat- Hyper Pyrexia
Chemical,
Trauma,
cancer

14. TYPES
 Primary encephalitis
 Secondary encephalitis
 Infectious encephalitis
 Auto immune encephalitis/post infectious encephalitis
 Chronic encephalitis
 Limbic encephalitis
 HIV encephalitis
 Encephalitis lethargica &Japanese Encephalitis

15. PRIMARY ENCEPHALITIS
 This condition occurs due to viral infection or
other agent directly infects brain.
 The infection may be concentrated in one area or
wide spread.

16. SECONDARY ENCEPHALITIS
 It results from a impaired immune system
reaction to the infection elsewhere in the body.
 Instead of attacking the infected cells normal
brain cells are affected.
 Its otherwise known as post infectious
encephalitis.

17. INFECTIOUS ENCEPHALITIS
 Viruses are the most common cause of
infectious encephalitis.
 Rare cause:
Bacteria: mycoplasma, meningococcal,
pneumococcal, listeria
fungi: Histo plasma, Cryptococcus, Candida
parasites: Malaria, Toxo plasmalitis virus

18. AUTO IMMUNE ENCEPHALITIS
It refers to a group of conditions that occur when
the body's immune system mistakenly attacks
healthy brain cells , leading to inflammation of the
brain. People with autoimmune encephalitis may
have various neurologic and/or psychiatric
symptoms

19. CHRONIC ENCEPHALITIS
Chronic encephalitis and epilepsy
(Rasmussen's encephalitis) is a rare progressive
disorder of uncertain etiology that usually occurs in
children, producing focal epilepsy, hemiparesis,
and intellectual deterioration

20. LIMBIC ENCEPHALITIS
It is caused by autoimmunity: an abnormal state
where the body produces antibodies against itself.
Some cases are associated with cancer and some
are not

21. ENCEPHALITIS LETHARGIA
It is an atypical form of encephalitis. Also known as
"sleeping sickness" or "sleepy sickness"
(distinct from tsetsy fly(parasite)-transmitted
sleeping sickness).

22. HIV ENCEPHALITIS
It refers to cognitive impairment resulting from
productive cerebral infection by the human
immunodeficiency virus. It does not apply to
opportunistic infections resulting from generalized
cell mediated immunodeficiency.

23. JAPANESE ENCEPHALITIS
It is caused by Japanese encephalitis virus
(JEV) is a flavi virus related to dengue, yellow
fever and West Nile viruses, and is spread by
culicine mosquitoes.
JEV is the main cause of viral encephalitis in
many countries.
It occurs in less than 15 years of aged children.
1/4th cases in northern India.

24. LIFE CYCLE OF VIRUS
Pig Mosquito Pig
Bird Mosquito Bird
MAN IS AN INCIDENTAL “DEAD END’’ HOST’

25. VIRUS ENTERS
THROUGH BLOOD
STREAM(AFTER
MOSQUITO BITE)
VIRAEMIA
VIRUS
TRANSPORTED TO
THE SITE OF BRAIN
VIA BLOOD
VIRUS
PROLIFERATES
REPLICATES THE
ENDOPLASMIC
RETICULAM &
GOLGI APPRATUS
DESTROY THEM IN
GREY MATTER
VIRUS ACROSS THE
VASCULAR
ENDOTHELIUM TO
THALAMUS,BRAIN
STEM
AFFECTS BASAL
GANGLIA
CEREBRAL EDEMA
PATHOPHYSIOLOGY

26. Fever
Headache
Lethargy
Vomiting
Behavioral
Changes
Changes In
Conscious
CLINICAL MANIFESTATIONS

27. Seizures
Motor
Weakness
Hypothermia
Increased
Deep Tendon
Reflex
Dysphagia
Dysarthria
CLINICAL MANIFESTATIONS

28. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Complete blood count/culture/viral seroogy
 CT/MRI,EEG
 Polymerase chain reaction (PCR) amplification or
a test to check for antibodies against certain
viruses
 ELISA

29. CONT…
CSF ANALYSIS/LUMBAR PUNCTURE
 Normal /Slightly low glucose
 Leucocytosis
 Increased proteins
 Increased mononuclear cell pleocytosis
Others :
 Brain biopsy

30. COMPLICATIONS
Amnestic
syndrome
Motor and
sensory
deficits
SepticemiaComa/death
Seizures

31. TREATMENT
 Cytomegalovirus Infection: Gangiclovir, Foscavir
 Toxoplasmosis Infection: Pyrimethamine
&Sulfadoxine
 Herpes simplex virus: Acyclovir
 Varicella zoster: Acyclovir, Gangiclovir or adjunctive
corticosteroids
 Bacterial Infection: Antibiotics-Penicillin(Neuro
syphilis)

32. CONT…
 Supportive treatment: Mannitol&
Corticosteroids(dexamethasone)-Cerebral edema
 Anticonvulsants/IV Lorazepam-Seizure
Management
 Bed rest
 Plenty of fluids
 Acetaminophen-pain medications to help reduce
fever and relieve body aches
 Sedatives

33. NURSING MANAGEMENT
• Monitor fever frequently, institute fever management
and administer drugs
• Maintain fluid balance – prevent overload of IV fluids to
reduce complication of cerebral edema and also
prevent dehydration
• Enhancing cerebral perfusion by administration of
drugs to maintain the intracranial pressure.
• Pain management

34. NURSING DIAGNOSIS
• Hyperthermia related to infectious process and
cerebral edema
• Ineffective cerebral tissue perfusion related to
infectious process and cerebral edema
• Acute pain(head and neck) related to meningeal
irritation
• Impaired physical mobility related to motor weakness
• Risk for injury related to seizure

35. REFERENCES
.Books:
1.Hasper, Fauci, Hauzer et.al,(2015) “HARRISON’S
Principles of Internal Medicine” Published by Mc
Grew hills companies, 19th Edition.
2.Smeltzer.Suzanne co et al, “Text book of Medical
Surgical Nursing” Published by Elsevier,12th Edition:
Page no-1953-1955. Year -2010,Volume-1
Web sources:
 www.encephalitis.in
 www.mayoclinic.in