Some of the symptoms of brainstem encephalitis.
Headache, fever, physical weakness, and lack of appetite. In more severe cases of brainstem encephalitis, brain function is significantly affected, causing irritability, restlessness and drowsiness. The most severe symptoms are weakness in the muscles of the arms or legs, difficulty with double vision (diplopia), speech and hearing, and in some cases, drowsiness that turns into unconsciousness.
Mild brainstem encephalitis is common and may even go unnoticed. However, mild brainstem encephalitis occurs in about one in a thousand cases of measles. The degree of risk depends on the age of the patient and the type of infectious agent causing the brainstem encephalitis.
While brainstem encephalitis can be fatal in infants and the elderly, people of other ages may recover completely from brainstem encephalitis, sometimes after a long period of serious illness. Although brainstem encephalitis may cause permanent damage to the brain, the percentage of serious consequences is low.
1. Systemic toxemia symptoms.
Fever, headache, body pain, nausea, vomiting, and malaise. A few have hemorrhagic rash and myocarditis manifestations. The fever duration is about 7-10 days.
2, neurological symptoms.
Disorders of consciousness, signs of meningeal irritation. After the second day of illness, flaccid paralysis of the cervical and scapular muscles may occur, resulting in head droop and inability to raise the arms, shaking and unsupported. Cerebral nerve and lower extremity involvement is rare. The paralysis can be recovered in about 2-3 weeks, and about half of the muscles are atrophied. Mild cases may have no obvious neurological symptoms.
Types.
Grade I: manifests as myotonic tremor and ataxia, leaving permanent neurological sequelae in 5% of patients.
Grade II: Myocardial tremor and cranial nerve involvement, which can lead to sequelae in 20% of patients.
Grade III: manifests as rapid cardiopulmonary failure, 80% of patients die, and survivors have severe sequelae.
Diagnosis.
Leukocytes 1 to 20,000, neutrophilic elevation.
Cerebrospinal fluid pressure is slightly elevated, cell count is usually below 0.2×109, and lymphocytes are in the majority. Sugar and chloride were normal.
The diagnosis is confirmed by a 4-fold or more increase in the potency of a double serum or a 1:16 or more increase in the potency of a single serum. The diagnosis can be confirmed by a 4-fold or more increase in the potency of a double serum or a single serum with a potency of 1:320 or more.
At the beginning of the disease, the virus is isolated from serum and cerebrospinal fluid, but the positive rate is low, and the virus can be isolated from brain tissue after death.
Principles of treatment.
Some of the most dangerous brainstem encephalitis (e.g., that caused by herpes simplex virus) can now be treated with drugs such as aconitine, or acyclic aconitine, or interferon. Although the efficacy of these drugs is still being evaluated, it is always a chance to treat dangerous brainstem encephalitis that would otherwise kill the patient. Since most of the other viruses that cause brainstem encephalitis do not respond to antibiotic drugs, the basic treatment is to take steps to moderate the symptoms and allow the body’s natural defenses to overcome the infection. In most cases, it is enough to stay comfortable and well-nourished. Sometimes, steroid medications can suppress inflammation. If the inflammation has become unconscious, feed the patient with a nasogastric tube and use a ventilator to assist with breathing. Recovery from severe brainstem encephalitis may be slow and may require special treatment, learning. Basic skills such as speaking clearly.
Disease care.
1. Prevention of infection.
Reduce infection triggers. Patients are given nasal feedings because of difficulty swallowing, and because of the patient’s resistance
Low resistance, coupled with not eating through the mouth, prone to oral infection, daily oral care with saline and 0.1% acetic acid alternately. Keep the room air fresh and sunny, disinfect with ultraviolet light once a day, wipe the bed unit items and the ground with disinfectant, and keep the patient’s skin clean and dry.
2.Care during ventilator-assisted breathing.
(1) Closely observe the vital signs and mechanical ventilation, auscultate the lungs every 2h and make detailed records. Observe whether the respiration is synchronized with the ventilator, and look for the cause immediately when the ventilator alarms, and exclude them in time.
(2) Ensure the pipeline of ventilator circuit is smooth, disinfect daily, and promptly dump the accumulated water in the collection bottle to prevent its backflow causing bacterial multiplication.
(3) Airway wetting by regular drops of saline plus chymotrypsin and dexamethasone in the airway to ensure no obstruction also facilitates dilution of sputum, which can be easily aspirated to reduce pulmonary complications.
(4) Ultrasonic nebulized inhalation 6 times a day, encourage spontaneous coughing, assist in patting the back, and use postural drainage and other methods to make sputum expelled smoothly.
3.Medication care.
Long-term application of glucocorticosteroids can have various side effects, mainly infection, diabetes, increased blood pressure, aggravation of ulcer disease, osteoporosis, etc. During the medication period, closely observe whether patients have skin infections, vomiting blood and other symptoms, regularly check blood, urine sugar and other relevant laboratory tests, and pay attention to the rebound phenomenon in the process of dose reduction. The application of neurotrophic drugs and other biological agents may cause allergic reactions, and increase the number of rounds. The use of gammaglobulin may cause leukopenia, pay attention to the review of blood routine, and notify the doctor in time if you find bad hair.
4. Diet care.
Reasonable diet is closely related to physical recovery. Because of the patient’s prolonged nausea and vomiting, swallowing difficulties caused by gastrointestinal dysfunction and water-electrolyte imbalance, coupled with hyperthermia in a state of high consumption so that weight loss is obvious, through nasal feeding supply with high protein, high nutrition, high vitamin fluid diet combined with intravenous rehydration.