ENCEPHALITIS

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ENCEPHALITIS
This is the inflammation of the cerebral tissue, topically accompanied by meningeal inflammation that is caused by viral infection.

CAUSES
1. Viral infection
2. Bacteria infection
3. Post infection e.g. Respiratory or GIT infection
4. HIV/AIDS

TYPES 
There are two main types of encephalitis:
• Primary encephalitis. This condition occurs when a virus or other agent directly infects the brain. The infection may be concentrated in one area or widespread. A primary infection may be a reactivation of a virus that had been inactive after a previous illness.
• Secondary encephalitis. This condition results from a faulty immune system reaction to an infection elsewhere in the body. Instead of attacking only the cells causing the infection, the immune system also mistakenly attacks healthy cells in the brain. Also known as post-infection encephalitis, secondary encephalitis often occurs two to three weeks after the initial infection.

Risk factors
• Age. Some types of encephalitis are more common or more severe in certain age groups. In general, young children and older adults are at greater risk of most types of viral encephalitis.
• Weakened immune system. People who have HIV/AIDS, take immune-suppressing drugs or have another condition causing a weakened immune system are at increased risk of encephalitis.
• Geographical regions. Mosquito- or tick-borne viruses are common in particular geographical regions.
• Season of the year. Mosquito- and tick-borne diseases tend to be more common in summer in many areas. 

Clinical manifestation
1. Nausea and vomiting
2. Seizure
3. Hemiparesis
4. Fever
5. Headache
6. Dysphagia
7. Atasia
8. Aphasia

Diagnostic Evaluation
1. Lumbar puncture with evaluation of the CSF will reveal leaucocytosis
2. EEG may demonstrate slow brain wave complexes
3. Brain tissue biopsy indicates presence of infectious agent.
4. Brain imaging with CT scan or MRI CT scans and MRI detect changes in brain structure

Management
Treatment is based on the Cause and symptoms
- Anticonvulsant to manage Seizure
- Corticosteroid  (to reduce brain inflammation)
- Analgesics for headache
- Synthetic ADH e.g. Pitressin to manage Diabetes insipidus
- support with breathing, such as oxygen through a face mask or a breathing machine (ventilator)

Nursing management
- Admit patient in a quiet environment and provide care gently, avoiding over activity and agitation which may cause increase ICP.
- Maintain Seizure precautions with side rails padded, airway and suction at bed side.
- Monitor Vital signs and neurological status closely.
- Restrict fluid to passively dehydrate the brain.
- Administer antipyretic and other cooling measures as indicated.
- Monitor fluid intake and output and provide fluid replacement through IV lines as needed
- Reorient patient to person place and time.
- Maintain strict universal /standard precaution.

Precautions
- Promote vaccination of patient, family and significant others for measles mumps and rubella.
- Patient and family education : explain the effects of the disease process, encourage follow up for evaluation of deficits and rehabilitation progress.

Nursing Diagnosis 
a. Altered cerebral tissue perfusion related to the inflammation of the cerebral tissue 
b. Risk for injury related to Seizure and edema 
c. Hypertermia related to infection process evidence by temperature of 38°c. 

Complications 
1. Psychosis 
2. Coma
3. Brain Abscess
4. Hearing or vision defects
5. Speech impairments





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