Encephalitis is an inflammation of the brain that is commonly caused by viral infections. It can cause symptoms like fever, headache, confusion, seizures, and neurological deficits as the brain tissue deteriorates. Diagnosis involves lumbar puncture to analyze CSF for signs of inflammation and PCR or antibody tests to identify the specific virus. Treatment focuses on managing symptoms, reducing fever and swelling, and using antiviral medications for viral causes. Nursing care involves frequent monitoring, preventing complications, managing aberrant behaviors, and providing supportive care and patient education.

1. ENCEPHALITIS

2. • Encephalitis is an inflammation of cerebral
tissue, typically accompanied by
meningeal inflammation.
• Meningoencephalitis is most commonly
caused by a viral infection. Like
meningitis, encephalitis can be infectious
or noninfectious and acute, subacute, or
chronic

3. Definition
• Encephalitis is an acute
inflammation of the brain. Most
often caused by virus , although it
can caused by bacteria
• Encephalitis with meningitis is
known as meningoencephalitIs

4. Types
Primary encephalitis
• The brain or spinal cord is
the predominate foci of the
toxin or pathogen.
Secondary encephalitis:
• It is caused by an infection
that is spread from another
part of the body.
Viral
• Resolves without specific
treatment within two
weeks it is also called as
aseptic meningitis
• Eg : Herpes simplex virus
• Arboviruses
Bacterial
• Quite severe and may
results brain damage,
hearing loss, learning
disability and also
causes death.
Fungal
• It is much less common
than the other two
infections. It is rare in
healthy people but it is
more likely in persons
who have impaired
immune system.

5. Post ischemic inflammatory encephalitis:
• It occurs due to brain inflammation
following a CVA. In patients with cerebral
ischemia, inflammation can result in
secondary brain injury, and microvascular
occlusion can be caused by activated
leukocytes or a microvascular thrombus.
This edema can result in increased ICP and
compromised cerebral perfusion.
Post infectious encephalomyelitis:
• It follows a viral or bacterial infectious
process.

6. ETIOLOGY
• Virus : herpes simplex virus,
arboviruses
• Bacteria
• Fungus
• Cva
• Immunosuppressed
• Upper respiratory infections

7. Pathophysiology
Progressive deterioration of nerve tissue
Edema and increased ICP
Local necrotizing hemorrhage that becomes more
generalized
Inflammation in brain parenchyma and neuronal cells
Microbial growth and Multiplication in the cerebral
tissue
Crosses the blood–brain barrier or direct entry
Microbial invasion

8. Signs and symptoms
• Symptoms may develop hours or weeks
after exposure.
• The symptoms include fever, headache,
and brain aberration (eg, disorientation,
neurologic deficits, seizures).
• Increased ICP may result in alteration in
consciousness, nausea, and vomiting.

9. • Motor weakness, such as hemiparesis,
may be detected.
• Increased deep tendon reflexes and
extensor plantar response are noted.
• Bizarre behavior and personality
changes may present at onset.
• Hypothalamic-pituitary involvement
may result in hypothermia, diabetes
insipidus, SIADH

10. Neurologic symptoms may include
• Superior quadrant visual field defects,
• Aphasia, dysphagia, ataxia and
paresthesias
• The patient with brainstem
encephalitis may present with
• Nystagmus,
• Decreased extraocular movements,
• Hearing loss,
• Dysphagia, dysarthria,
• Respiratory abnormalities, and motor
involvement.

11. Complications
• Cognitive disabilities and personality
changes
• Seizures
• Motor deficits
• Blindness

12. DIAGNOSIS
• Lumbar puncture, with evaluation
of CSF, is performed to detect
leukocytosis, increased
mononuclear cell pleocytosis,
increased proteins, and normal or
slightly lowered glucose.

13. Polymerase chain reaction (PCR)
• Polymerase chain reaction analysis of
the virus' deoxyribonucleic acid
(DNA), and the detection of
intrathecally produced viral
antibodies, are essential in diagnosing
the specific virus (eg, herpes simplex
virus, cytomegalovirus).

14. • EEG may demonstrate slow brain
wave complexes in encephalitis.
• MRI differentiates post infectious
encephalomyelitis from acute viral
encephalitis.
• Brain tissue biopsy indicates
presence of infectious organisms

15. Medical Management
• VIRAL encephalitis – Acyclovir,
Ganciclovir
• Antipyretics to reduce fever
• Diuretics – reduce risk of cerebral edema.
• Anticonvulsants
• Intravenous acyclovir over 10 to 21 days
is indicated for herpes simplex virus.
• Mothers who have genital herpes simplex
may be treated with acyclovir during the
third trimester to avoid shedding the
virus to their babies.

16. NURSING MANAGEMENT
• Obtain patient history of recent infection,
animal exposure, tick or mosquito bite,
recent travel, exposure to ill contacts.
• Before delivery, women should be
questioned regarding a history of
congenital herpes simplex virus and
examined for evidence of this virus; a
cesarean delivery should be explored with
the physician.

17. • Perform a complete clinical assessment
• Monitor for increased ICP
• Breathing assistance
• IV fluid to enhance hydration
• Preventing Injury
• Promoting Cerebral Perfusion
• Relieving Fever
• Monitor temperature and vital signs frequently.
– Administer antipyretics and other cooling measures as
indicated.
– Monitor fluid intake and output, and provide fluid
replacement through I.V. lines as needed.
• Be alert to signs of other coexisting infections, such as UTI or
pneumonia
• Managing Aberrations in Thought Processes
• Orient to person, place, time

18. Nursing Diagnoses
• Ineffective Tissue Perfusion
(cerebral) related to disease process
• Hyperthermia related to infectious
process
• Disturbed Thought Processes due to
personality changes
• Risk of Infection related to
transmittal.
• Risk for Injury related to seizures and
cerebral edema