This document discusses meningitis and encephalitis. It defines meningitis as an infection of the meninges and encephalitis as an inflammation of the brain parenchyma. It outlines the different types of meningitis and common causative organisms. It describes the clinical features, investigations, complications, prognosis and treatment for both conditions. The goals of physical therapy for patients with these inflammatory central nervous system disorders are also mentioned.

1. MENINGITIS
BY – AYUSHI KOYANI (FY MPT)
GUIDED BY – DR. VAISHALI SUTHAR MA’AM

2. CONTENTS
Introduction
Pathology
Clinical features
Investigations
Complications
Differential diagnosis
Prognosis
Treatment

3. INTRODUCTION

4. TYPES OF MENINGITIS
BACTERIAL MENINGITIS / ACUTE PYOGENIC
MENINGITIS
TUBERCULOUS MENINGITIS
ACUTE VIRAL MENINIGITIS

5. ACUTE BACTERIAL MENINGITIS
Acute bacterial meningitis is an acute infection of the subarachnoid
space and meninges characterizes by polymorphonuclear cells in the
cerebrospinal fluid (CSF).
Bacteria may invade the subarachnoid space directly by spread from
contiguous structure, e.g. sinuses, or more commonly indirectly from
the bloodstream.

6. Causative organisms
In neonates – gram -ve bacilli, e.g. E. coli, Klebsiella.
In children – Haemophiles influenzae. Pneumococcus,
meningococcus
In adults – Pneumococcus, Meningococcus
Host factors – congenital or acquired immune deficiency, predispose
to infection, overcrowding and poverty.
May occur following head injury, mastoiditis or after lumbar
puncture.

7. Nasopharyngeal colonisation
Replication & growth
Blood
Subarachnoid Space invasion
Replication of subarachnoid space
Infection & inflammation of sub arachnoid space
Pathology

8. Clinical features
c/f are present on the basis of 3 main causes:
• Infection
• Increased ICP
• Meningeal inflammation & irritation
Meningitis symptoms
• Severe frontal/occipital headache
• Stiff neck
• Fever, vomiting
• Photophobia

9. Meningitis sign :
•Neck stiffness
•Kernig's sign +ve
•Brudzinski's sign +ve

11. C/FACCORDING TO STAGE OF
MENINGITIS :
STAGE-1 STAGE OF INVASION:
Sudden onset
Severe head ache
Vomiting
Fever
Neck and back pain
Convulsion
Insomnia
Severe confusion

12. STAGE-2 MENINGEAL STAGE :
More severe head ache
Lumbar pain
Muscular stiffness & neck stiffness
Kernig's & Brudzinski's signs +ve
Muscular twitching & tenderness
Temperature variable
Exaggerated DTR
Sensory loss
Sensory neural deafness
Pulse : slow & irregular

13. Continue…
Pupils
Unequal & sluggish reaction
Dilated & fixed
Ptosis
Diplopia- double vision
Seizures
Other features
Facial paralysis
Dysphagia
Incoordination
Urine retention
constipation

14. INVESTIGATION
1) CT SCAN :
 Excludes focal neurological deficit, increased ICP or other
complications

15. 2) CSF EXAMINATION :
 Increased pressure (>300 mm of H20)
 Purulent appearance
 Thick & greenish- pneumococcal
 Thin & yellow- strepto/ staphylococcal
 Increased total cell count >1000/ml
 Increased protein 1.0-5.0gm/lit
 Sugar decreased or absent
 Chloride & lactate decreased

16. 3) Blood :
 Increased total blood count
 Increased ESR
 Culture isolate organism
4) Serum electrolytes :
Increased frequency
5) X-ray :
 chest- pneumonia
 Skull- #

17. COMPLICATIONS
1) Septicaemia
2) Arthritis
3) neurological complications
Cerebral oedema
Focal neurological damage
Psychiatric problems
Hydrocephalus
Cranial nerve palsies

18. 4) Cardio-vascular complications
Myocarditis
Bacterial endocarditis
5) Electrolyte imbalance
6) Shock

19. DIFFERENTIAL DIAGNOSIS
Poliomyelitis
Acute disseminated encephalomyelitis
Acute encephalitis
Cerebral abscess
Sub arachnoid haemorrhage

20. PROGNOSIS
Over all prognosis- good
Depends upon different factors
E.g. Infective organism
Response to antibiotics
Stages of illness when pt comes
Presence of complications
Over all mortality- 15-25%

21. TREATMENT

22. PT EVALUATION OF THE
PATIENT WITH MENINGITIS
1. Observation of current functional status of the patient
2. Assessment of standard vital signs
3. Assessment of cognitive status
4. Assessment of sensory integrity
5. Assessment of movement abilities
6. Assessment of functional abilities

23. AIMS OF THE PT INTERVENTIONS
Optimization of postural control
Optimization of functional activities with selective voluntary
movement pattern control
Improvement of performance of functional activities
Enhancement of integration of sensory information
Optimization of cognitive status and psychosocial responses

24. ENCEPHALITIS

25. INTRODUCTION
Encephalitis is a non-suppurative inflammation of the parenchyma of
the brain which contain neuronal and glial cell damage with associated
inflammation and oedema.
The inflammatory process can also involve the spinal cord i.e.
encephalomyelitis.
Viral encephalitis is a worldwide disorder with the highest incidence.

26. Virus causing encephalitis :
• Enterovirus
• Herpes simplex (usually type 1)
• Mumps virus
• Influenza virus
• Varicella zoster
• Japanese encephalitis virus

27. The most common virus responsible for large-scale epidemic in
India is Japanese B encephalitis virus.
It is spread by mosquito that extensively in rice ecosystem.
In adults, >90% of cases of herpes simplex encephalitis result from
infection with HSV-1.
In children, influenza virus is an important cause of encephalitis.

28. CLINICAL FEATURES
GENERAL : pyrexia, myalgia
Specific to causative virus,
Meningeal involvement (slight) – neck stiffness, cellular response in
CSF.
Sign and symptoms of parenchymal involvement – focal / diffuse.

30. INVESTIGATION
CT SCAN : In temporal lobes with surrounding oedema.
CSF : Increased pressure
•Protein levels are mildly elevated
•Cell count is increased
EEG : periodic high voltage slow wave complexes over the
involved temporal lobe.

31. DIFFERNTIAL DIAGNOSIS
Post infectious encephalomyelitis
Bacterial or tubercular infections of the brain

32. PROGNOSIS
It is highly variable, in chronic cases high mortality is seen.
Many may be left with residual deficit like dementia, focal deficits
and epilepsy.
Complications remain such as flexion deformities of arms,
hyperextension of the legs, language impairment, learning difficulties
and behavioral problems.
Many recover completely if the illness is mild.

33. TREATMENT
General measures to care for the unconscious patient should be started.
Anticonvulsants are often necessary.
Dexamethasone 4 mg 6 hourly for brain oedema.
HSE responds well to acyclovir (10 mg/kg IV 8 hourly for 14-21 days)

34. The goals of therapeutic intervention program
for patients with inflammatory CNS disorders :

35. REFERENCE
Lindsay – Neurology & Neurosurgery Illustrated, 4th edition
Mathew – Medicine, 5th edition
Darcy – Umphred’s neurological rehabilitation, 6th edition