P-OT027. Approach and management of suspected encephalitic patients in omdurman teaching hospital

• Published in: Clinical neurophysiology Vol. 132; no. 8; p. e129
• Main Author: Eltahier Abdalla Omer, Mohammed
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-08-2021
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2021.02.324

Introduction. The aim of this study was to assess the approach and management of suspected encephalitic patients in Omdurman teaching hospital.
Methods. This was a cross-sectional descriptive study, conducted on 84 patients who are suspected of encephalitis in neurology department. The data was analyzed using SPSS.
Results. The commonest group of age affected (21–40) representing about 66.7% with 84.5% female predominant and most of the patients from Khartoum state (58.3%). Regarding the main presenting symptoms, 100% presented with fever and headache, 36.9% with seizure and 28.6% with agitation, other symptoms like abnormal behavior, memory disturbance, photophobia, neck stiffness and nausea / vomiting ranging from (22.6–8.3%). 1.2% has a history of SLE and also 1.2% presented with bilateral 6th cranial nerve lesion. 28.6% presented with unconsciousness and disoriented. 13.1% comatose with 20.2% had personality changes and memory disturbance. Regarding upper and lower limbs examination 13.1% hemiparesis, 4.8% quadriparesis and 1.2% paraparesis. 100% did a CBC showed lymphocyte predominant about 70.2%, 100% elevation in ESR. 71 patients did a CSF analysis with 83.1% showed abnormality, increasing lymphocyte cells, others were normal. MRI/CT scan was done in 50 patients;, in 63.2% MRI showed temporal hyperintense lesion, whereas CT scan was normal in majority of cases (71%). EEG was abnormal in 3.6% of cases. Most of the cases were managed empirically with antiviral and antibiotics, 100% and 94% respectively. About 85.7% received antiepileptic. The most common complication was seizure (85.7%). 26.2% ended up with motor deficit. Fortunately, most of the cases completely recovered (65.5%).
Conclusion. The diagnostic approach to patients with encephalitis must include CSF, neuroimaging (MRI) plus or minus EEG. Empirical antimicrobial therapy for patients with suspected encephalitis should include rapid administration of intravenous acyclovir at appropriate dosages if clinically suspected despite unobtainable CSF result. We must identify the exact etiology and once an etiologic agent of encephalitis is identified, antimicrobial therapy should be targeted to that infectious agent, or therapy should be discontinued if treatment directed against the etiologic agent is not available.