Encephalitis – Definition: Encephalitis is an acute inflammation of the brain tissue, usually caused by a viral infection, but can also result from bacterial, fungal infections or autoimmune responses. Key Points: Most commonly caused by viruses like Herpes Simplex Virus (HSV), Japanese Encephalitis Virus, or Arboviruses. Can affect cerebral function, leading to symptoms like fever, headache, confusion, seizures, and altered consciousness. May be life-threatening and requires prompt diagnosis and treatment

1. Case presentation on
Encephalitis
PRESENTED BY-
DR. NASIR UDDIN

2. Encephalitis:
Encephalitis is inflammation of the tissues of the brain caused by infection or an autoimmune
response.

3. Causes;
 It can develop due to a direct brain infection with a virus, bacteria, or fungus. It can also
occur when the immune system responds to a past infection and the immune system
mistakenly attacks brain tissue.
There are three main categories of viruses that cause primary encephalitis:
 common viruses, including herpes simplex virus (HSV) and Epstein-Barr virus
 childhood viruses, including measles and mumps
 arboviruses, which spread through mosquitoes, ticks, and other insects
 Secondary encephalitis is often a complication of a viral infection. Symptoms start to appear
days or even weeks after the initial infection.

6. Symptoms;
 Fatigue
 Headache
 High fever
 Mild to moderate neck stiffness
 Confusion
 Drowsiness
 Seizures
 Loss of speech
 Loss in movements in body

7. Diagnosis;
 Brain imaging
 Spinal tap, known as a lumbar puncture
 Electroencephalogram (EEG)
 Body imaging
 Brain biopsy
 Other lab tests- Samples of blood, urine or excretions from the back of the throat can be
tested for viruses or other infectious agents.

8. Subjective data:
Patient name; Lakshmi Age/sex; 68/F
COMPLAINTS; c/o fever since 2days, c/o altered senses, weakness of limbs , headache
HISTORY OF PAST ILLNESS ; fever with vomiting episodes since 3 days
O/E ; PR- 100bpm
spo2; 98%
BP- 130/90mmhg

9. OBJECTIVE DATA:
EXAMINE VALUES NORMAL RANGE
Haemoglobin 8.8% 12-15%
RBC 2.9gms% 4.2-5.4gms%
WBC 6,600cells 4500-11000cells
Platelet count 2.1lakhs/cumn 150000-450000lakhs/cumn
RBS 113mg/dl 110-140mg/dl
Serum creatinine 0.7mg/dl 0.5-1.5mg/dl
sodium 141mmol/l 135-145mmol/l
potassium 3.3mmol/l 3.5-5.2mmol/l
CSF FOR ADA 7.1 2-10u/l
Blood urea 26mg/dl 6-24mmol/l

10. MRI BRAIN PLAN;
 FINDINGS: diffusion restriction foci with corresponding low ADC in bilateral frontal lobes, left
capsuloganglionic region and right temporal lobe- acute infarcts.
 IMPRESSION:
 Acute infarcts in bilateral frontal lobes, left capsuloganglionic region and right temporal lobe.
 Mild DNS to right . Right inferior turbinate hypertrophy. Mild left mastoid effusion.

11. CT BRAIN:
 IMPRESSION;
o small vessel ischemic changes
o age related cerebral atrophy changes
SEROLOGY REPORT
Dengue NS1 antigen : Negative
Dengue igG: Negative
Dengue igM: Negative

12. WIDAL TEST (tube method)
 Salmonella typhi “O” Antigen-1:160
 Salmonella typhi “H” Antigen -1:160
 salmonella paratyphi “AH” Antigen-<1:20
 Salmonella paratyphi “BH” Antigen-<1:20

13. Based on subjective data & objective data patient
was diagnosed with encephalitis

14. TREATMENT CHART
DRUG COMPOSITION DOSE INDICATION ROA FQ SIDE EFFECTS
Inj.
meropen
em
Meropenem
trihydrate
500mg antibiotic IV OD Bluish lips,
confusion
Inj.vanco
mycin
Vancomycin
HCL
500mg antibiotic IV OD Kidney damage,
hearing loss
T.
trypace
Trypsin+rutosid
e
100mg analgesic PO OD Nausea, heartburn
T.nodosis Na+bicarbonate 500mg antacid PO BD Increased thirst,
bloating
T.
glutathio
ne
Glycine +
cysteine
60mg antioxidant PO OD Flatulence, weight
gain
T. alocate Vitamin +
calcium
250mg vitamin
supplement
PO OD Constipation,
dizziness
T. strocit citicoline 500mg Treat brain PO BD Insomnia, blurred

15. T.pan pantoprazol
e
40mg antacid PO OD Flatulence,
stomach
pain
T.parkitidin
e
amantadine 100mg Anti
parkinson
PO OD Constipatio
n,
hallucinatio
n
T. Levipill levetiracetam 500mg Anti-
epileptic
PO BD Headache,
irritation
T. atorfit-
CV
clopidogrel+
atorvastatin
75/10mg Anti-
platelet
PO BD Rash,
diarrhoea
T. acyclovir Acyclovir
drug
800mg Treat
antiviral
infections
PO BD Headache,
diarrhoea

16. The given prescription is rational / irrational ?
There is no interaction found between prescribed drugs. So the
given prescription is rational.

17. DISCHARGE SUMMARY
vitals
BP-130/80mmhg
PR-100bpm
RR-20cpm
SPO2-99%
Discharge medication
 T.parkitidine-100mg/PO/OD
 T. levipill-500mg/PO/BD
 T.atorfit-500mg/PO/BD
 T.strocit-500mg/PO/BD
 T. nodosis-250mg/PO/OD
 T. pan-40mg/PO/OD
 T. acyclovir-800mg/PO/BD

18. PATIENT COUNSELLING;
 Recovery : patient may feel tired for months after recovering from encephalitis. Patient
have to take time to pace themself and focus on high-priority activities. Patient can also
try to develop good sleep habits, eat a healthy diet, and exercise regularly.
 Patient need to attend therapies like physical therapy, occupational therapy, speech
therapy and psychotherapy.
 If patient notice any changes like confusion, drowsiness, loss of speech, etc… you have to
consult your health care provider.
 In the diet patient have to include fruits, vegetables, antioxidant foods & avoid refined
foods and sugar in your diet.