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Abstract: The patient, a 56-year-old male, presented to the hospital 4 days ago with a fever of no apparent cause, accompanied by mild headache and nausea, and gradually worsened confusion 2 days before admission. The main clinical manifestations of meningoencephalitis are fever, headache and parenchymal symptoms, such as convulsions and psychiatric symptoms, which can be mild or severe.
Basic information】Male, 56 years old
Disease Type】Meningoencephalitis
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】February 2022
Treatment plan】Medication (injectable ganciclovir, wake-up call injection, mannitol injection, human immunoglobulin, injectable imipenem cistatin sodium) + physical cooling (antipyretic patch, ice bag cooling) + psychological counseling and comfort
[Treatment period] 12 days of hospitalization, 1 month of outpatient follow-up
Effectiveness of treatment】Resolution of fever and unconsciousness
I. Initial consultation
The patient complained of a history of hypertension and diabetes mellitus. 4 days before admission, he developed fever without any obvious cause, and his body temperature fluctuated from 38.5℃ to 39.6℃, accompanied by slight headache, full head distension, nausea, but no vomiting. 2 days before admission, he showed confusion and gradually worsened, but he could answer questions briefly after waking up, and his limbs did not twitch and could move. The patient was given a head MRI, lumbar puncture, blood culture and routine blood tests, and was recommended to be hospitalized for treatment.
The patient’s examination after admission showed: poor general status, shortness of breath, specialist examination showed drowsiness, inability to cooperate with the examination, bilateral pupils were equally round, reflex to light existed, no facial palsy, but sensory examination was uncooperative, pathological signs of both lower limbs were not elicited, head MRI showed: multiple lacunar cerebral infarction with dilated ventricular system. The lumbar puncture examination showed: cerebrospinal fluid sugar 2.9 mmol/L, cerebrospinal fluid chloride 124.0 mmol/L, cerebrospinal fluid pressure 280 mmH2O, cerebrospinal fluid albumin 1027 mg/L, cerebrospinal fluid cell count 90. After combining the above findings, the patient was considered to have meningoencephalitis.
II. Treatment history
After detailed communication with the patient regarding his condition and treatment plan, the patient was prescribed ganciclovir antiviral for injection, wake-up call injection for cerebral protection, mannitol injection for dehydration to lower cranial pressure, human immunoglobulin intravenous drip, imipenem cistatin sodium for injection for anti-inflammation, as well as general physical cooling, including antipyretic patch and ice bag for cooling, and psychological counseling to comfort the patient.
III. Treatment effect
Through 12 days of drug treatment, the patient’s symptoms of fever and unconsciousness were significantly relieved, body temperature dropped to normal, nausea and vomiting disappeared, and mental outlook was better than before, and discharge was granted. The patient was advised to pay attention to rest and drink more water after discharge, come to the outpatient clinic for regular review after 1 month, and was advised to go to the endocrinology department for detailed consultation and treatment to regulate blood sugar.
IV. Notes
We are glad that the patient’s symptoms of fever and unconsciousness were significantly relieved after timely medication and physical hypothermia treatment. However, it is recommended that the patient still needs to pay attention to the following matters after discharge from the hospital.
1. It is recommended that the patient’s daily diet should be light, avoiding cold and raw stimuli, quitting smoking and alcohol, and maintaining adequate nutrition. Also appropriate physical activities, such as walking, can be carried out.
2. Make sure to follow the doctor’s instructions and go to the hospital for review in time to monitor whether the disease is in complete remission, and if there is any other discomfort, it can be found and treated in time.
V. Personal insight
The patient had a febrile onset and rapidly became unconscious. Considering that the lesion involved the whole brain, if treatment is delayed, the patient may develop persistent status epilepticus, hydrocephalus, pus accumulation, brain abscess, etc. When the inflammation widely affects the meningeal vessels, thrombosis may also occur, causing stroke, hemiparesis, aphasia, etc., and even affecting life safety. Fortunately, treatment is timely and the condition is in remission. Most patients have increased intracranial pressure, which can even cause brain herniation leading to patient death in severe cases. Therefore, it is important to seek medical attention in a timely manner to avoid delaying the condition when uncomfortable symptoms appear.