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Abstract: The patient in this case was a 73-year-old male who presented with fever, headache, nausea with abnormal mental status before admission. The patient was given a complete head MRI, lumbar puncture, blood culture, routine blood tests, and diagnosed with multiple lacunar cerebral infarction and bacterial encephalitis, and was instructed to be hospitalized for treatment.
Basic information】Male, 73 years old
Disease Type】Bacterial encephalitis
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (mannitol injection, brain-awakening injection, human immunoglobulin (pH4), ceftriaxone sodium for injection)
[Treatment period] Hospitalization for 10 days
Effectiveness】The patient’s fever and headache were relieved, and he was discharged from the hospital in good spirits.
I. Initial consultation
The patient, male, 73 years old, developed fever with no obvious cause on the 13th day before admission, with temperature fluctuating between 37-39℃, accompanied by headache, full head distension, nausea, and no vomiting; abnormal mental status on the 5th day before admission, mainly showing no response to questions and answers, entering sleep after a few seconds, waking up, with incontinence, and movable limbs. After admission, the patient was given MRI of the head, lumbar puncture, blood culture, routine blood tests and so on.
II. Treatment history
The patient’s physical examination after admission: the patient’s general condition was fine, the specialist examination showed that the patient was indifferent, the language was fine, the pupils were rounded bilaterally with a diameter of about 3.0 mm, the light reflex existed, the eyes sought all activities freely, there was no facial palsy, the tongue was stretched out in the middle, the neck strength was positive, the limbs could move, the tendon reflex existed symmetrically, the sensory examination was not abnormal, the neck strength was positive, the pathological signs of both lower limbs were positive.
The cephalometric magnetic resonance showed multiple lacunar cerebral infarcts, and DWI did not show diffusion-limited signal; lumbar puncture showed cerebrospinal fluid sugar 2.5 mmol/L, cerebrospinal fluid chloride 125.0 mmol/L, cerebrospinal fluid pressure 245 mmHg, cerebrospinal fluid albumin 879 mg/L, and cerebrospinal fluid cell count 40. The final diagnosis was bacterial encephalitis with multiple lacunar cerebral infarcts.
Then, we gave intravenous infusion of waking brain static injection for cerebral protection, mannitol injection for dehydration to lower the cranial pressure, and ceftriaxone sodium for injection for anti-inflammatory treatment, and also gave the patient sedative human immunoglobulin (pH4) for symptomatic support treatment.
III. Treatment effect
The patient was hospitalized for 10 days, the fever and headache were relieved, the body temperature dropped to normal level, the heart rate, blood pressure and respiration were not abnormal, the sleep state was restored, the patient was conscious, the speech was acceptable, the patient’s mental outlook was better than before, and no adverse drug reactions occurred during the drug administration, so the patient was discharged home, and the patient was advised to take rest and drink more water. After the patient was discharged from the hospital, he was reviewed regularly at the outpatient clinic and was followed up for one month.
IV. Precautions
After timely and effective treatment, the patient’s symptoms were relieved and he was successfully discharged from the hospital, and I am truly happy for him. However, this patient needs long-term and effective care and treatment. Therefore, it is necessary to advise the patient and his family to create a good living environment, pay attention to proper ventilation in daily life, and avoid the patient receiving adverse stimuli such as too much cold and too much heat. Patients are also advised to maintain a good state of mind and pay attention to emotional regulation; they can exercise appropriately and choose suitable exercise methods; their diet is based on light and highly nutritious food, with appropriate protein supplementation to enhance their physical fitness.
V. Personal insight
Bacterial encephalitis often has fever accompanied by brain parenchymal symptoms, such as babbling and mental disorders, etc. Lumbar puncture of the cerebrospinal fluid may appear to be reduced sugar, chloride, normal blood sugar, lumbar puncture pressure is often greater than 200 mm water column, cerebrospinal fluid protein content is elevated, cerebrospinal fluid culture of specific bacteria can be clearly confirmed, before the diagnosis is usually given anti-inflammatory and other empirical treatment, usually the choice of antibiotics that can easily cross the blood-brain barrier, such as ceftriaxone. The use of antibiotics that can easily cross the blood-brain barrier, such as ceftriaxone, and the use of long-term antibiotics also requires attention to the presence of fungal infections. Patients need to be closely monitored during hospitalization, such as temperature changes, family members need to observe the patient’s state of consciousness, and doctors need to observe the patient’s vital signs and changes in blood indicators such as blood count and C-reactive protein to prevent the disease from progressing to a serious state.