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Abstract: Meningoencephalitis is an inflammatory disease involving the meninges or brain parenchyma, which may manifest as severe headache, nausea and vomiting, often accompanied by fever, abnormal blood count, and in severe patients, cranial magnetic resonance may show brain parenchymal involvement. The patient came to the clinic with no obvious cause of headache, accompanied by nausea and vomiting, and fever, and was diagnosed with meningoencephalitis after examination. After combined drug treatment, the headache and fever symptoms were significantly relieved.
Basic information】Male, 32 years old
Disease Type】Meningoencephalitis
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】February 2022
Treatment plan】Medication (injectable ganciclovir, gaucamycin hydrobromide injection, mannitol injection, human immunoglobulin, ceftriaxone sodium for injection, moxifloxacin hydrochloride tablets) + psychological counseling and comfort
Treatment period】7 days of inpatient treatment, regular outpatient follow-up
Effectiveness of treatment] Relief of headache and fever
I. Initial consultation
The patient had a headache with no obvious cause on the 4th day before admission, with severe head swelling and unbearable pain, accompanied by nausea and no vomiting, with fever up to 38℃, and no relief of the appeal symptoms after taking cold medicine. One day before admission, the patient’s headache worsened, accompanied by bilateral eye swelling and pain, accompanied by nausea and vomiting, vomiting three times, vomit is the contents of the stomach, but no numbness and weakness of the limbs, so the patient came to the hospital. The patient was first given a head MRI, lumbar puncture and other examinations. The patient was also advised to be hospitalized for treatment.
The patient’s physical examination after admission showed no signs on cardiopulmonary examination, abdominal tenderness, no resistance, no pressure pain and rebound pain. Specialized examination showed clear consciousness, no sensory abnormalities, and no pathological reflexes were elicited. The later head MRI showed: multiple lacunar cerebral infarcts and cerebral white matter demyelination. Lumbar puncture examination showed: cerebrospinal fluid sugar 3.10 mmol/L, cerebrospinal fluid chloride 125.0 mmol/L, cerebrospinal fluid pressure 300 mmH2O, cerebrospinal fluid albumin 1627 mg/L, and cerebrospinal fluid cell count 50. Combining the patient’s symptoms and examination results, the patient was diagnosed with meningoencephalitis.
II. Treatment process
After detailed communication with the patient, it was decided to give the patient antiviral with injectable ganciclovir, pain relief with gaufferin hydrobromide injection, dehydration and cranial pressure reduction with mannitol injection, intravenous drip of human immunoglobulin, and anti-inflammatory with injectable ceftriaxone sodium and oral moxifloxacin hydrochloride tablets, as well as psychological counseling and comfort.
III. Treatment effect
Through the combined treatment of drugs, the patient’s headache and fever symptoms were significantly relieved, the body temperature dropped to normal, nausea and vomiting disappeared, and the patient was discharged at 7 days of hospitalization, and was advised to continue to take oral moxifloxacin hydrochloride tablets for anti-inflammation, pay attention to rest, drink more water, and be reviewed at the outpatient clinic after 1 month.
IV. Precautions
The patient’s condition has improved after active treatment, and we are truly happy for him. It is recommended that if the patient has fever and headache again, he must seek medical attention in time, because fever accompanied by headache is not only a manifestation of cold, but also an intracranial infection formed by microorganisms entering the skull through the blood-brain barrier, which is more dangerous, so it should be taken seriously, and if necessary, lumbar puncture should be performed to clarify whether there is intracranial infection. In addition, after discharge from the hospital, we should pay attention to avoid catching cold and flu, pay attention to rest and sleep, improve nutrition, and increase resistance. Pay attention to a light diet and avoid eating spicy and stimulating foods. Follow the doctor’s instructions to take the medication on time and in the right amount, do not stop or reduce the medication by yourself.
V. Personal insight
The main reason is to treat the pathogenic microorganism. Once the bacterial infection is identified, antibiotics such as moxifloxacin hydrochloride sodium chloride injection should be started immediately. And for the treatment of meningoencephalitis, early treatment is the key to improve the prognosis, so it is important to seek medical examination and treatment in a timely manner. Usually, the treatment effect is the same as that of the patient, which can lead to significant relief of symptoms.