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Abstract: A male patient came to the hospital with complaints of headache, occasional nausea and vomiting, a history of flu half a month ago, and a positive meningeal stimulation sign on physical examination. The patient was then admitted to the hospital for drug treatment. After 14 days, the patient’s symptoms improved, and the headache, nausea and vomiting were relieved until they disappeared, and the indexes of all tests were normal.
Basic information】Male, 38 years old
Disease Type】Meningoencephalitis
Hospital】Shandong Provincial Third Hospital
Date of consultation】May, 2020
Treatment plan】Medication (ceftriaxone sodium + ganciclovir + mannitol + glycerol fructose)
Treatment period】Inpatient treatment for 14 days, followed up by outpatient treatment after 1 month
Treatment effect】Headache, nausea and vomiting symptoms were relieved until they disappeared.
I. Initial consultation
A male patient came to the hospital complaining of headache, occasional nausea and vomiting, along with low-grade fever. He complained that he had a cold half a month ago, and now he had a legacy of headache, and asked for some painkillers. Examination of the patient revealed positive signs of meningeal irritation, therefore headache and nausea caused by high intracerebral pressure could not be excluded and intracranial lesions need to be alerted. The patient was advised to complete a cranial magnetic resonance examination, the results of which suggested meningoencephalitis, and the patient was then admitted to the hospital.
II. Treatment
After admission, the patient underwent routine blood tests, C-reactive protein and lumbar puncture, which indicated high leukocyte and neutrophil ratios, and combined with the results of cranial magnetic resonance, the diagnosis of meningoencephalitis was confirmed. Based on the laboratory results, antibiotics and antiviral drugs that can easily penetrate the cerebrospinal fluid were selected, and drugs to lower cranial pressure and reduce cerebral edema, such as ceftriaxone sodium + ganciclovir + mannitol + glycerol fructose, were also given, and the patient was discharged after 14 days of continuous treatment. The patient was discharged after 14 days with good recovery. The patient was instructed to follow up in outpatient clinic after 1 month.
III. Treatment effect
After the combined treatment, the patient’s intracerebral edema and intracerebral hypertension were reduced. 7 days after the treatment, the headache was significantly relieved, and the lumbar puncture rechecked the cerebrospinal fluid indicators were significantly lower than before. 14 days later, the patient indicated that the headache, nausea and vomiting disappeared, and the cerebrospinal fluid indicators were normal on recheck, so the patient was discharged. 1 month later, the patient returned to the hospital for follow-up, and indicated that he had no special discomfort and was recovering well.
IV. Notes
We are glad that the patient’s headache, nausea and vomiting have been relieved and disappeared after active drug treatment. However, it is recommended that the patient still needs to pay attention to the following matters after discharge.
1.After discharge, they should take the medication according to the doctor’s requirements on time and in accordance with the dosage, and avoid stopping the medication by themselves so as not to lead to the recurrence or aggravation of the symptoms. If the headache with no obvious cause appears again and is difficult to be relieved, they need to seek medical attention in time, and should not use the medication blindly and arbitrarily so as not to aggravate the condition.
2. Normally, you should improve your immunity and develop good habits of work and rest to reduce the occurrence of infectious diseases. The recovery period should be a light diet, moderate exercise, and ensure good sleep.
V. Personal insight
Meningoencephalitis is associated with severe intracranial infection and is one of the neurological emergencies. Untimely treatment may leave sequelae and affect the patient’s future life and work. When there are positive signs of meningeal irritation or explosive headache with jet-like vomiting, cranial examination should be actively improved and intracranial disease should be alerted. The headache should be monitored in detail during treatment, and follow-up of cerebrospinal fluid laboratory results as well as brain MRI should be noted.