Encephalitis is inflammation of the brain parenchyma that can be caused by viral infections. Common symptoms include fever, headache, and altered mental status ranging from confusion to coma. Diagnosis involves lumbar puncture showing lymphocytic pleocytosis and elevated proteins in CSF. Treatment involves antivirals, managing increased intracranial pressure, and treating complications like seizures. Outcomes depend on virus virulence and patient factors, with risk of long-term neurological deficits and even death in severe cases. Nursing care focuses on monitoring for neurological changes, preventing injuries, and providing comfort throughout the illness and recovery process.

1. ENCEPHALITIS
Dr. RS MEHTA, MSND, CON
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2. Encephalitis: Infectious process &
inflammatory response limited to
brain parenchyma.
Meningoencephalitis: Meninges +
brain
Encephalomyelitis: Brain + spinal
cord
Encephalomyeloradicilitis: brain +
spinal cord + nerve root
Dr. RS MEHTA, MSND, CON
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3. J. ENCEPHALITIS
Flavivirus
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4. Year
JE Cases
Death
1993
446
108
1994
1836
283
1995
1246
255
1996
1450
260
1997
2953
407
Dr. RS MEHTA, MSND, CON
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5. No.of cases
Average month wise distribution of
subjects(1993-20000
700
600
500
400
300
200
100
0
650
25
May
100
75
July
25
Sept.
Oct.
Nov
Months
Dr. RS MEHTA, MSND, CON
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6. ENCEPHALITIS
• Encephalitis is the inflammation of the brain
parenchyma, presents as diffuse and/ or
focal neuropsychological dysfunction.
• From an epidemiologic and pathophysiologic
perspective, encephalitis is distinct from
menningitis though on clinical evaluation the
two often coexist with the sign and
symptoms of meningeal inflammation such
as photophobia, headache or a stiff neck.
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7. • Viral infection is the most
common and important cause,
with over 100 viruses implicated
worldwide
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8. PATHOPHYSIOLOGY
Portal of Entry
Mosquito
Transmit virus to the body
Hematogeneous Spread or neural and
olfactory pathways.
Crosses BBB
Enters neural cells
Disruption in cell functioning
 Perivascular congestion
Haemorrhage
Inflammatory response
Dr. RS MEHTA, MSND, CON
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9. • In acute encephalitis, cerebral edema and
petechial hemorrhages occur throughout the
hemispheres, brain stem, cerebellum, and,
occasionally, spinal cord.
• Direct viral invasion of the brain usually
damages neurons, sometimes producing
visible inclusion bodies.
• Severe infection, particularly untreated
encephalitis, can cause brain hemorrhagic
necrosis.
Dr. RS MEHTA, MSND, CON
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10. Sign and Symptoms
Initial Signs
•
•
•
•
•
Headache
Malaise
Anorexia
Nausea and Vomiting
Abdominal pain
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11. • Symptoms
– Fever
– Headache
– Behavioral changes
– Altered level of consciousness
– Focal neurologic deficits
– Seizures
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12. Developing Signs
• Altered LOC – mild lethargy to deep coma.
• Altered Mental State – confused, delirious,
disoriented.
• Mental Disorders:
–
–
–
–
–
hallucinations
agitation
personality change
behavioral disorders
occasionally frank psychosis
• Focal or general seizures in >50% severe cases.
• Severe focused neurologic deficits.
Dr. RS MEHTA, MSND, CON
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13. • The classic presentation is
encephalopathy with diffuse or focal
neurologic symptoms, including the
following:
–Behavioral and personality changes,
decreased level of consciousness
–Stiff neck, photophobia, and lethargy
–Generalized or localized seizures
–Acute confusion or amnestic states
–Flaccid paralysis (10%)
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14. Dr. RS MEHTA, MSND, CON
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15. Dr. RS MEHTA, MSND, CON
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16. Neurologic Signs
• Virtually every possible focal neurological
disturbance has been reported.
• Most Common
– Aphasia
– Ataxia
– Hemiparesis with hyperactive tendon reflexes
– Involuntary movements
– Cranial nerve deficits (ocular palsies, facial
weakness)
Dr. RS MEHTA, MSND, CON
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17. Summary C/F
•
•
•
•
•
•
•
•
•
•
Acute febrile illness : Meningitis + Encephalitis
Confusion, behavioural changes
Altered LOC: lethargy & coma
Focal / Diffuse neurological S/S
Frank psychotic status
Focal/Generalized seizures
Focal findings: aphasia, ataxia, hemiparesis
Increase DTR, Increase planter
Involumentry movement, tremor, myoclonic jerk
Ocular palsy/facial weaknes
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18. Differential diagnosis
•
•
•
•
•
•
•
•
Brain absess
Subarachnoid hemorrhage
SLE
Toxoplasmosis
Hypoglycemia
Meningitis
Status epilepticus
Tuberculosis
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19. Lab findings: Summary
•
•
•
•
•
•
CSF: LP all suspected cases
DLC: Lymphocyte
Protein: Mildly elevated
Sugar: Normal (> 45 mg/dl) in viral
RBC in CSF: 20%, RBC > 500 /L
MRI/CT: Mass lesion / basal meningitis /
hydrocephalus
• Brain biopsy: previously gold standard – now CSF
• CSF PCR has become the primary diagnostic test
for CNS infections caused by CMV, EBV, VZV,
Dr. RS MEHTA, MSND,
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HHV-6, and enteroviruses. CON

20. CSF Parameters
CONDITION
CELL TYPE
CELL
COUNT
NORMAL
LYMPHOCYTES
0-4*108 /L
VIRAL
LYMPHOCYTES 10-2000
BACTERIAL
POLYMORPHS
TUBERCULO P+L MIXED
US
GLUCOSE PROTEIN
GRAM
STAIN
>60% of
Blood
glucose
Upto 0.45g/l
(-)
Normal
Normal
(-)
10005000
Low
Normal/
elevated
+
50-5000
Low
Elevated
Often (-)
FUNGAL
LYMPHOCYTES 50-500
Low
Elevated
(+/-)
MALIGNANT
LYMPHOCYTES 0-100
Low
Normal/
elevated
(-)
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21. TREATMENT
1. EMERGENCY MANAGEMENT
• Evaluate and treat for shock or hypotension.
Administer a crystalloid infusion until the patient is
euvolemic.
• Consider airway protection in patients with an
altered mental status.
• Consider seizure precautions. Treat seizures
according to usual protocol (ie, lorazepam 0.1
mg/kg given intravenously [IV]).
• Stabilize alert patients with normal vital signs by
administering oxygen, securing IV access, and
providing rapid transport to the ED.
Dr. RS MEHTA, MSND, CON
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22. Medication
Antivirals
• The goal of the use of antivirals to shorten the
clinical course, prevent complications,
prevent the development of latency and/or
subsequent recurrences, decrease
transmission, and eliminate established
latency
1. Acyclovir (Zovirax)
Adult
• 10 mg/kg (infuse over 1 h) IV q8h for 14-21 d
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23. 2. Foscarnet (Foscavir)
• Adult
• 40 mg/kg IV q8h for 14-26 d
3. Dexamethasone
• Adult
• 10 mg IV q6h
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24. Managing complications
• Signs of hydrocephalus and increased ICP
– General measures: Manage fever and pain,
control straining and coughing, and avoid
seizures and systemic hypotension.
– In otherwise stable patients, elevating the head
and monitoring neurologic status usually are
sufficient.
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25. - When more aggressive maneuvers are indicated,
some authorities favor the early use of diuresis
(eg, furosemide 20 mg IV, mannitol 1 g/kg IV)
provided circulatory volume is protected.
Dexamethasone 10 mg IV q6h helps in managing
edema surrounding space-occupying lesions.
- Hyperventilation (PaCO2 30 mm Hg) may cause a
disproportional decrease in cerebral blood flow
(CBF), but it is used to control increasing ICP on
an emergency basis only.
Dr. RS MEHTA, MSND, CON
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26. –Intraventricular ICP monitoring is
controversial because some authorities
believe dangerous focal edema with a
pressure gradient between the temporal
lobe and the subtentorial space usually is
not detected by the monitor, leading to a
false sense of security. In fact, monitor
placement may potentially aggravate a
pressure gradient.
Dr. RS MEHTA, MSND, CON
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27. Follow up
1. Further inpatient care:
• Admission of the patient to the hospital, as
necessary.
2. Prevention
• Immunization against JE is recommended
for those traveling into endemic areas
during high-risk times of year and this must
be explained to the patient
Dr. RS MEHTA, MSND, CON
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28. Complications
• Seizures
• Syndrome of inappropriate secretion of
antidiuretic hormone
• Increased ICP
• Coma
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29. Prognosis
•
The prognosis depends on the virulence of the
virus and on variables associated with the
patient's health status, such as extremes of age,
immune status, and preexisting neurologic
conditions.
–
–
–
high rates of mortality and severe morbidity, including
mental retardation, hemiplegia, and seizures.
Increased mortality and morbidity rates are found in
patients who are older than 60 years.
Long-term sequelae include behavioral disorders,
memory loss, and seizures.
Dr. RS MEHTA, MSND, CON
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30. CONTROL
• Biological control of natural vertebrate :
impractical
• Arthropod control : effective method
• Personal protection
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31. NURSING ASSESSMENT
• Poor personal hygiene
• High fever and convulsions
• Dehydration
• Irritability and restlessness
• Baby's parents, anxiety about
prognosis, complications & life
threatening sequences.
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32. NURSING PRIORITIES
The top most Nursing priorities are:
1. Vital status and neurological status
2. Hygienic needs - care of mouth hair and skin.
2. Physical comfort - support of mother(child), calm &
clean environment, comfortable position and bed.
3. Nutritional needs - Nutritional balance during illness.
4. Elimination needs - change of soiled linen
5. Safety needs providing bed railings, pads, splinting etc.
6. Special care during fever, fits, lumbar puncture, etc.
7. Communication needs - reassurance and confidence.
8. Psychological and spiritual needs - mental and moral
support
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33. NURSING INTERVENTIONS
1. Monitor vital signs and neurological status and record
a. Tepid sponging if febrile.
b. Hot water bottle if chill
c. Attach to nasal oxygen if needed
2.Provide a comfortable bed with pillows or soft pads
supported by railings to prevent injuries due to fall.
3. Provide a mackintosh and draw sheet to reduce
complications of bed-wetting.
4. Change soiled linens as frequently as needed to avoid
bed sores.
5. Provide calm and dim - lighted environment to reduce
irritability.
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34. 6. Give morning, evening and bed time care or as
required viz. oral hygiene, partial bath, combing
and nail cutting to maintain good personal
hygiene.
7. Give parentral nutrition as needed & maintain I.V.
Infusion / naso gastric tube.
8. Encourage small frequent feeds.
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35. 9. Admit timely attention and
aseptic precautions.
10. Administer medicine after
checking the orders, labels, etc.
under direct supervision to avoid
confusions or misuse of drugs.
11. Change the bed linen whenever
necessary.
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36. 12. During fever
a. Give plenty of oral fluids.
b. Maintain fluid balance
c. Provide additional warmth by blanket if
needed
d. Provide proper ventilation.
Dr. RS MEHTA, MSND, CON
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37. 13. WHILE CONVULSIONS
1. Apply suction if needed to avoid secretions to
block airway,
2. Provide an air way to prevent tongue bite and
falling of tongue which blocks the air way.
3. Prefer lateral position for secretions to come out
and prevent aspiration.
4. Splint IV line to avoid unnecessary variation in
position of canula.
5. Protect the patient from injuries such as
chocking, aspiration of vomitus, a fall of head,
etc.
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38. 14. During LUMBAR PUNCTURE
1.Follow aseptic precautions.
2.Assist the doctor to do the procedure.
3.Put the patient in lateral position.
4.Have the patient's back arched so that his head
almost touch his knees.
5.Collect label and send the specimen promptly.
6.Don't disturb the patient from bed for 24 hours.
7.Elevate foot end of patient after lumbar
puncture
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39. 15. Frequently change the position to left lateral
& right lateral and give back care.
16. Maintain records of intake, output, vital
signs, convulsions (time, frequency,
duration, parts included type, etc), drug
administration, etc.
17. Explain the patient party about the
procedure to relieve anxiety and fear.
18. Provide facilities for daily prayers if desired,
allow visitors for particular time without
disturbing the patient
Dr. RS MEHTA, MSND, CON
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40. ADVICE ON DISCHARGE:
1. Regular medication should be followed.
2. Regular health check-up should be done.
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41. Some Common nursing Diagnosis of the client may be:
1. Altered thought process RT failure in memory and lack
of self protective behaviour.
2. Risk for injury RT the unpredictable behaviour and
inability to interpret environmental stimuli.
3. sleep pattern disturbance RT alteration in usual sleep
habits
4. Altered cerebral tissue perfusion RT increased ICP
5. Impaired verbal communication RT neuronal
degeneration.
6. Self care deficit RT loss of memory and motor
impairment.
7. Incontinence RT neural degeneration and
forgetfulness.
Dr. RS MEHTA, MSND, CON
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42. Dr. RS MEHTA, MSND, CON
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