Presented by-

Ms. Lendina Longkumer

Bsc(N) Tutor
CON, CIHSR
 INTRODUCTION
• 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.
 DEFINITION
• Encephalitis is an inflammation of the brain
that is caused especially by infection with a
virus (such as herpes simplex or West Nile
virus) or less commonly by bacterial or fungal
infection or autoimmune reaction.
 ETIOLOGY
• The exact cause of encephalitis is often
unknown.
• But when a cause is known, the most common
is a viral infection. Bacterial infections and
noninfectious inflammatory conditions also
can cause encephalitis.
 COMMON VIRAL CAUSES
• The viruses that can cause encephalitis include:
• Herpes simplex virus (HSV). Both HSV type 1 —
• associated with cold sores and fever blisters
around your mouth — and HSV type 2 —
associated with genital herpes — can cause
encephalitis. Encephalitis caused by HSV type 1 is
rare but can result in significant brain damage or
death.
• Enteroviruses. These viruses include the poliovirus
and the coxsackievirus, which usually cause an
illness with flu-like symptoms, eye inflammation and
abdominal pain.
• Mosquito-borne viruses. These viruses can cause
infections such as West Nile, western equine and
eastern equine encephalitis. Symptoms of an
infection might appear within a few days to a couple
of weeks after exposure to a mosquito-borne virus.
• Tick-borne viruses. The Powassan virus is
carried by ticks and causes encephalitis in the
Midwestern United States. Symptoms usually
appear about a week after a bite from an
infected tick.
• Rabies virus. Infection with the rabies virus,
which is usually transmitted by a bite from an
infected animal, causes a rapid progression to
encephalitis once symptoms begin. Rabies is a
rare cause of encephalitis in the United States.
• Childhood infections. Common childhood
• infections — such as measles (rubeola),
mumps and German measles (rubella) — used
to be fairly common causes of secondary
encephalitis. These causes are now rare in the
United States due to the availability of
vaccinations for these diseases
Other causes of encephalitis may include-

• An allergic reaction to vaccinations

• Autoimmune disease
• Bacteria such as tuberculosis
 CLASSIFICATION
• 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.
 TYPES OF ENCEPHALITIS
1. Infectious Encephalitis-
- Inflammation occurs as a direct result of viral
infection. Viral encaphalitis may develop
during an infection with viral illnesses like
influenza, herpes simplex etc.
2. Post infectious encephalitis- The inflammation
caused by the immune system reacts to a
previous infection or vaccine.
3. Autoimmune encephalitis:
-Encephalitis caused by the immune system reacting
to a non infectious cause, such as a tumour or
antibodies.
4. Japanese Encephalitis (JEV)-
-A viral infection spread by mosquitoes.
5. Chronic Encephalitis-
- Can be the result of a condition such as HIV. There
are two types:
• A. Subacute sclerosing Panencephalitis- The
inflammation occurs as a complication of a
measles infection
• B. Progressive Multifocal
Leukodystrophy(PML)- caused usually by
harmless virus known as JC virus.
 CLINICAL MANIFESTATIONS
• Encephalitis is inflammation of the brain
which is slightly life threatening. It usually
begins with flu-like symptoms such as:
• Fever
• Severe headache
• Nausea and vomiting
• Joint pain
After this initial stage, ,more serious symptoms
can begin to develop, which may include:
- Changes in mental state, such as confusion,
drowsiness or disorientation
- Seizures
- Loss of sensation or paralysis in certain areas
of the body
- Loss of consciousness
 Other symptoms include
• Photophobia
• Inability to speak
• Muscle weakness
• Stiff neck
• Hallucinations
• Involuntary movements of the eyes, face,
arms and legs
Herpes simplex virus encephalitis
• There are 2 HSVs: HSV 1 AND HSV 2
• 1 typically affects children and adults
• HSV-2 most commonly affects neonates who
acquire the disease from a mother who has an
active genital herpes infection at the time of
delivery.
 PATHOPHYSIOLOGY
• Local necrotizing hemorrhage

• Becomes more generalized

• Edema

• Progressive deterioration of nerve cell bodies.

 CLINICAL MANIFESTATIONS
• Fever
• Confusion
• Hallucination
• Focal seizures
• Dysphagia
• Hemiparesis
• Altered LOC
• Other herpes viruses. These include the
Epstein-
• Barr virus, which commonly causes infectious
mononucleosis, and the varicella-zoster virus,
which commonly causes chickenpox and
shingles
ASSESSMENT AND DIAGNOSTIC FINDINGS

• EEG: shows diffuse slowing or focal changes in

the temporal lobe.
• CSF: Lumbar puncture often reveals a high
opening pressure, glucose within normal limits
and high protein levels in CSF samples.
• MRI – study of choice for detection of early
changes caused by HSV-1: study shows edema
in the frontal and temporal lobes.
• PCR (Polymerase chain reaction)- standard
test for early diagnosis
 MEDICAL MANAGEMENT-
• Antiviral agents, either acyclovir or ganciclovir
are the medications of choice in the treatment
of HSV
• Treatment should continue for 3 weeks to
avoid relapse.
ARTHROPOD- BORNE VIRUS ENCEPHALITIS

• Maintained in nature through biologic

transmission between susceptible vertebrate
hosts by blood feeding
arthropods(mosquitoes)
 PATHOPHYSIOLOGY
• Viral replication occurs at the site of the
mosquito bite

• Virus gains access to the CNS via the olfactory

tract resulting in

ENCAPHALITIS
 CLINICAL MANIFESTATION
• Headache and fever
• DizZiness
• Nausea and malaise
ASSESSMENT AND DIAGNOSTIC FINDINGS

• CSF
• MRI
• EEG
 MEDICAL MANAGEMENT
• No specific management, therefore
management is key
• Control of seizures and increased ICP
 Fungal encephalitis
• Rarely occurs in healthy people
• Causes include-
-Cryptococcus neoformans
-Blastomyces dermatitidis
-Candida
-Aspergillus fumigatus
 PATHOPHYSIOLOGY
• The fungal spores enter the body via inhalation

• Inially infect the lungs causing vague respiratory symptoms

or pneumonitis

• Fungi may enter bloodstream causing fungemia

• May spread to CNS

• ENCEPHALITIS
 CLINICAL MANIFESTATION
• Fever
• Malaise
• Headache
• Cranial nerve dysfunction
ASSESSMENT AND DIAGNOSTIC FINDINGS

• CSF- usually indicates elevated white cells amd

protein levels, decreased glucose levels
• MRI- study of choice
 MEDICAL MANAGEMENT
• Antifungals like Amphotericin B.
• Fluconazole.
 NURSING MANAGEMENT
• Performing neurological assessment- monitor
neurologic status
• Monitor patient’s response to therapy and
adverse reactions
• Maintain patent airway
• Intake and output count
• Quiet environment to avoid excessive stimulation
and agitation which may cause increase ICP
• Maintain seizure precautions
• Reorient patient frequently
• Administer antipyretics
 COMPLICATIONS
• Loss of memory
• Behavioral/personality changes
• Epilepsy
• Fatigue
• Physical weakness
• Intellectual disability
• Lack of muscle coordination
• Vision problems
• Hearing problems
• Speaking issues
• Coma
• Difficulty breathing
 DIAGNOSIS

• Ineffective Tissue Perfusion (cerebral) related to

infectious process and cerebral edema
• Risk for Imbalanced Fluid Volume related to
fever and decreased intake
• Hyperthermia related to the infectious process
and cerebral edema
• Acute Pain related to meningeal irritation
• Impaired Physical Mobility related to prolonged
bed rest
 GOAL

• To Enhanced Cerebral Tissue Perfusion

• To Maintain Fluid Balance
• To Reduce Fever
• To Reduce Pain
• To Return to Optimal Level of Functioning/
mobility
 INTERVENTIONS
• Enhancing Cerebral Perfusion
• Assess LOC, vital signs, and neurologic parameters
frequently. Observe for signs and symptoms of ICP (eg,
decreased LOC, dilated pupils, widening pulse pressure).
• Maintain a quiet, calm environment to prevent
agitation, which may cause an increased ICP.
• Prepare patient for a lumbar puncture for CSF
evaluation, and repeat spinal tap, if indicated. Lumbar
puncture typically precedes neuroimaging
• Notify the health care provider of signs of
deterioration: increasing temperature, decreasing LOC,
seizure activity, or altered respirations.
• Maintaining Fluid Balance
• Prevent I.V. fluid overload, which may worsen
cerebral edema.
• Monitor intake and output closely.
• Monitor CVP frequently.
 Reducing Fever

• Administer antimicrobial agents on time to

maintain optimal blood levels.
• Monitor temperature frequently or
continuously, and administer antipyretics as
ordered.
• Institute other cooling measures, such as a
hypothermia blanket, as indicated.
 Reducing Pain

• Administer analgesics as ordered; monitor for

response and adverse reactions.
• Avoid opioids, which may mask a decreasing LOC.
• Darken the room if photophobia is present.
• Assist with position of comfort for neck stiffness,
and turn patient slowly and carefully with head
and neck in alignment.
• Elevate the head of the bed to decrease ICP and
reduce pain.
Promoting Return to Optimal Level of Functioning

• Implement rehabilitation interventions after

admission (eg, turning, positioning).
• Progress from passive to active exercises
based on the patient's neurologic status.
SUMMARY
THANK YOU!