POSTNATAL ENCEPHALITIS: A DIAGNOSIS NOT TO BE MISSED

Authors

  • Farhat Naz
  • Saqib Malik
  • Tariq Mehmood
  • Sumbal Tariq

Abstract

Background: Viral encephalitis is a common condition but only a few studies are available on
occurrence of viral encephalitis in postnatal women. The objective of this study was to determine the
frequency of postnatal encephalitis among patients presenting with cerebral neurological complications
during puerperium and to determine a response to 10 day course of acyclovir therapy and final outcome
of the patients. Methods: This cross-sectional descriptive study was conducted at Department of
Medicine, Unit A, Ayub Teaching Hospital, Abbottabad from Jan to Dec 2011. All patients presenting
with encephalitis in their postnatal period were enrolled. Eclampsia patients were excluded from study.
The diagnosis of encephalitis was made on clinical assessment, CSF routine examination, CT scan and
MRI. Results: Among patients 16 (84.2%) presented with fever, 13 (68.42%) with headache, 8
(42.1%) with meningeal irritation, 7 (36.84%) with hemiparesis, 18 (94.7%) with altered sensorium, 13
(68.42%) with seizures, and 7 (36.84%) with coma. Cerebrospinal fluid of 16 (84.21%) patient had the
changes consistent with viral encephalitis. It was normal in 2 (10.52%) patients and showed picture of
pyogenic meningitis in 1 (5.26%) cases. On CT scan of brain, 3 (15.78%) had normal scans, 3
(15.78%) had cerebral oedema, 4 (21.05%) had ischemic infarct, 3 (15.78%) had meningo-encephalitis,
2 (10.52%) had infarct plus cerebral oedema, 1 (5.26%) had encephalitis and 3 (15.78%) had infarct
plus haemorrhage. On MRI brain 15 out of 17 (88.2%) had lesions consistent with encephalitis. All 19
(100%) patients were treated with 10 days course of acyclovir and a broad spectrum third generation
antibiotic. After hospitalisation 11 (57.8%) patients were discharged with complete recovery, 5
(26.31%) were discharged with partial recovery and 3 (15.78%) patients expired. Conclusion: Clinical
presentation of the patient is most important in diagnosing viral encephalitis in postnatal women
especially when patient presents with fever, altered sensorium and convulsions. Acyclovir therapy
should be started without delay while awaiting other investigations.
Keywords: Encephalitis, postnatal, acyclovir

References

Gupta S, Rohatgi A, Sharma SK, Gurtoo A. A study of

neurological disorders during pregnancy and puerperium. Ann

Indian Acad Neurol 2006;9(3):152-7.

Czupryna P, Moniuszko A, Adamczyk-Przychodzeñ A,

Pancewicz SA, Kondrusik M, Zajkowska J. Viral encephalitis in

puerperium period -case report. Pol Merkur Lekarski

;28:401-3.

Dutta A, Tonkin T, Gelman W. Postpartum convulsions -a

diagnostic enigma. J R Soc Med 2006;99(4):203-4.

Sauerbrei A, Wutzler P. Herpes simplex and varicella-zoster

virus infections during pregnancy: current concepts of

prevention, diagnosis and therapy. Part 1: Herpes simplex virus

infections. Med Microbiol Immunol 2007;196(2):89-94.

Pauranik A, Jain S, Maheshwari MC. Herpes simplex virus

type-2 encephalitis in peripartum period preceded by hepatitis.

Jpn J Med 1987;26:84-7.

Whitley RJ. Herpes simplex encephalitis: adolescents and

adults. Antiviral Res 2006;71(2-3):141-8.

Raschilas F, Wolff M, Delatour F. Outcome of and prognostic

factors for herpes simplex virus encephalitis in adults: results of

a multicenter study. Clin Infect Dis 2002;35:254-60.

Utley TF, Ogden JA, Gibb A, McGrath N, Anderson NE. The

long-term neuropsychological outcome of herpes simplex

encephalitis in a series of unselected survivors.

Neuropsychiatry Neuropsychol Behav Neurol 1997;10:180-9.

Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL,

et al. The acquisition of herpes simplex during pregnancy. N

Engl J Med 1997;337:509-15.

McGrath N, Anderson NE, Croxson MC, Powell KF. Herpes

simplex encephalitis treated with acyclovir: diagnosis and long

term outcome. J Neurol Neurosurg Psychiatry 1997;63:321-6.

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Published

2012-06-01

How to Cite

Naz, F., Malik, S., Mehmood, T., & Tariq, S. (2012). POSTNATAL ENCEPHALITIS: A DIAGNOSIS NOT TO BE MISSED. Journal of Ayub Medical College Abbottabad, 24(2), 77–80. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/2197

Issue

Vol. 24 No. 2 (2012): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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