VIRAL ENCEPHALITIS

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT 

A 45-year-old female patient resident of Nakrekal agriculture worker (farmer) by occupation presented to the casualty with

CHIEF COMPLAINTS:- fever for 2 days, generalized body pains for 2 days, headache and neck pain for 1 day, and 2 episodes of vomiting 

HISTORY OF PRESENTING ILLNESS:-patient was apparently asymptomatic for 2days then he developed a high-grade fever which is continuous and not associated with chill, rigor, or any kind of rash and does not relieve on medication.

No history of weight loss, diurnal variation, burning micturition. 

Then she was taken to a local doctor where she was given the medication for fever and body aches (medication unknown) then she had an episode of non-projectile non-bilious vomiting.

Then she developed generalized body pains and neck pain by which she could not sleep.

 The next day she was taken to a bigger hospital where she was admitted and then had an episode of vomiting after drinking water which is projectile and the contents are water.All the routine investigations are done to find the cause but the investigations did not reveal any cause so she was referred to our hospital for further management

                      

PAST HISTORY: 

No h/o HTN,DM,asthma,thyroid disturbances,epilepsy,CAD,CKD

PERSONAL HISTORY: 

diet-mixed

Appetite-normal

Bowel and bladder-regular

Sleep-adequate 

Addictions- occasionally toddy and paan.

Extended personal history:- 

She is an agricultural worker who is economically poor. She has had blurring of vision for 1 year and started aspects intermittently.

When the patient works in the hot sun she has vomitings and get dehydrated and used to go to a local doctor for treatment .she intermittent low-grade fever attack for the past 1 year which resolved on medication.

On the day of the complaints, she was asymptomatic on the day and normally went to work in the fields and ate lunch during the lunch break, when she went to work she developed fever and generalized body pains

FAMILY HISTORY:- not significant 

TREATMENT HISTORY:- no relevant history 

ALLERGIC HISTORY:- no allergies to any kind of drugs and food items

GENERAL EXAMINATION: 

Pt was semi-conscious, c, cooperative, and well oriented to time place, and person.

Moderately built 

Pallor  +

Icterus  -

Cyanosis  -

Clubbing  -

Lymphadenopathy  -

Pedal edema   - 

VITALS:

BP:- 150/80 mmHg

PR:- 80 bpm

RR:- 20cpm

Spo2:- 96 on RA

SYSTEMIC EXAMINATION:

CNS: HIGHER MENTAL FUNCTIONS:

speech: Normal

Behavior: Normal 

Memory: Intact.

Intelligence: Normal

Lobar Functions: Normal.

No hallucinations or delusions.

CRANIAL NERVE EXAMINATION:

1st: Normal

2nd: visual field is normal 

        color vision normal

        fundal glow present.

3rd,4th,6th:  pupillary reflexes 

 EOM full range of movements gaze-evoked Nystagmus present.

5th: sensory intact motor intact

7th:  Normal

8th:  No abnormality noted.

9th,10th: palatal movements present and equal.

11th,12th: normal.

SUPERFICIAL REFLEXES:

   CORNEAL                                    present                                            present       

   CONJUNCTIVAL                         present                                            present

ABDOMINAL                                                             present

   PLANTAR                                     withdrawal                                      withdrawal

SIGNS OF MENINGEAL IRRITATION:

KERNIG TEST:- POSITIVE 

BRUDZINSKI SIGN :- POSITIVE 

INVESTIGATIONS:- 

LFT:-

CRP:-

CSF:-

ECG:-

NS1 ANTIGEN:-

ABG:- 

DIAGNOSIS:- 

VIRAL ENCEPHALITIS.