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Supervisor: dr. Wisman Dalimunthe, Sp.

A(K)
Presentator: Gina Kristina P
NIM: 100100183
 Infection of the CNS are among the most
common neurologic disorders encountered
by pediatricians.
 Viral encephalitis is a medical emergency.
 35%-50% patients are death, and 20-40%
patients are alive with residual clinical
manifestation.
 Encephalitis is the presence of an
inflammatory in the brain parenchyma
associated with clinical evidence of brain
dysfunction
 Most of which is virus. The common viral
infection is HSV-2, HSV1, VZV, CMV,EBV,
mumps, rubella, poliovirus, St. Japanese B,
etc.
 The non-viral causes of infectious
encephalitis include bacteria agents, for
exaple: Mycobacterium tb, Mycoplasma
pneumoniae, Salomenlla typhi, etc. And
fungal agents are cryptococcus, candidiasis,
histoplasmosis. And parasitic agents are
Toxoplasma gondii and schistosomiasis.
 Incidence / studies is higher in children
 Both genders are affected
 144 consecutive adults with encephalitis or
aseptic meningitis, viral etiology was
recognized in 72 patients, 46% of these cases
were attributed to eneteroviruses, 31% to
HSV-2, 11% to VCV, and 4% to HSV-1.

 Viruses enter the CNS through 2 routes: (1)
hematogenous dissemination, and (2)
retrograde neuronal dissemination.
 (1) seeding in the reticulocyte and muscle
 (2) may be associated with viral infection and
increased plasma concentration of chemokin

Clinical Manifestation:
 Febrile accompanied by headache, altered of
level consciousness, and sympomts and signs
of cerebral dysfunction.
 4 categories of cerebral dysfunction are:
◦ Cognitive dysfunction
◦ Behavioral changes
◦ Focal neurological abnormalities
◦ seizure
 Complete blood count is not specific
 Neuroimaging studies
◦ EEG  periodic lateralizing epileptiform discharge
◦ CT Scan
◦ MRI
 CSF analysis
 PCR
 Peripheral blood count and cellular
morphology

Encephalitis Bacterial
Meningitis
Viral
Meningitis
Tuberculosis
Meningitis
Brain Abscess
Pressure High High High High Very high
Macroscopic Clear Murky Clear Clear Clear
Protein Slightly
increased
High High Very high High
Glucose Normal Very low Normal Very Low Normal
Cloride Normal Low Normal Very low Normal/low
Cell Lymphocyte Neutrofil Lymphocyte Pleocytosis Pleocytosis
Gram Staining Negative Positive
(90%)
Negative Negative Sometimes
positive
Acid-fast
staining
negative negative negative Rarely positive negative
Culture for
bacterial
Negative Positive
(90%)
Negative Negative Sometimes
positive
Cuture for
microba
Negative Negative Negative Positive Negative
Viral culture Positive (30%) Negative Positive (70%) Negative Negative
 General therapy  5B
 Symptomatic therapy:
◦ Antioedem  dexamethasone 0.2mg/kgBB/iv,
mannitol 1-2mg/kgBB/6jam
◦ Seizure  diazepam 0.3-0.5mg/BW iv, phenytoin
100-200mg/12hours/days in NaCl.
 Causal therapy: acyclovir 10-
12.5mg/kgBB/8jam for 10 days


 As many as 60% of children with acute
encephalitis reported persistent symptoms at
long term follow up evaluation.
 Common residual symptoms were personality
changes, cognitive problems, headache, fatigue,
and irritability.
 Even children who are considered to have made a
full recovery at the time of discharge may suffer
from sequelae at long-term follow-up
evaluations. These results indicate that all
children with acute encephalitis should be
monitored for at least 6 to 12 months after acute
encephalitis.
7


•JOM
Name
• 8years 9months/ Female
Age/Sex
•23rd March 2014
Date of Admission
Main complaint:
decreased level of consciousness (+)

History:
•Decreased consciousness (+) since 3 hours before entering the
hospital and began with seizure.
•Seizure experienced since 5 hours ago, occured in the whole
body
•During a seizure, hands and feet stamping and wide-eyed to
the top.
•The duration of a seizure occured more than 5 minutes. The
frequency of seizures approximately 15 times.
•A history of seizures without fever (-). Fever occurs in 3 days. A
high fever is not relieved with antipiretics.
•Diarrhoea (-), a history of diarrhoea (-). Vomiting occurs in two
days, the frequency is two times, the volume is 70cc/times of
vomiting. Projectile vomiting (-).
•A history of headaches (-). A history of contact with a person
who cough in long period (-). History of bleeding (-). Urinary
(+), urinary catheter attached.


History of previous illness:
this patient is a patient referrals from Bidadari
hospital in Binjai by a pediatrician with a
diagnosis of suspected meningitis.


History of previous medication:
Steroid, phenitoin 1 amp.

History of immunization:
Not complete

Presens status
Sensorium: GCS7 (E2V2M3) BP: 100/70 mmHg
Temperature : 38.7
oC
Pulse: 149 bpm
Respiratory Rate : 20 x/minute

Physical Examination
Weight : 24 kg
Height : 118 cm
BW/Age: 85,7%
BH/Age: 90%
BW/BH: 109%
Upper Arm Circumference
(UAC): 13 cm

 Head: Eye: light reflexes (+/+), isocor pupil, pale
conj. Palp. Inferior (-/-), icteric (-/-), Ear : normal,
Nose: normal, Mouth: normal / rebreathing mask
(+), NGT (+)
 Neck: Lymph node enlargement (-)
 Thorax: Symmetrical fusiformis, retraction (- )
HR: 149 bpm, regular, murmur (-)
RR: 20 x/minute, regular, crackles (-/-),
stridor (+)
 Abdomen: soepel, peristaltic (+) normar,
Liver/Spleen/Renal: not palpable
 Extremities: Pulse 149 bpm, regular, less vascular
pressure and volume, cold acral, CRT > 3”.
Brudzinsky I/II (-), Kernig (-), Babinsky (+),
openheim (+)

 Working Diagnosis
Septic shock + encephalitis

 Differential Diagnose
Septic shock + DD/ Meningoencephalitis
Meningitis
 Treatment
Elevation head 30
O
with midline position
O
2
3liter/min by breathing mask
IVFD RL 20cc/kgBB immediately
Ceftriaxone inj 1g/12 hours/IV Skin test
Ampicillin 1gr/6h/iv
Dopamin continuous inj 75mg in 50cc
NaCl 0,9%  12cc/hours


S
Fever (+), decreased consciousness (+), seizure (+), NGT is brown
O Sensorium: GCS8, Body temperature: 38,1
o
C, Respiratory
Rate: 30x/minute, Heart Rate: 120bpm, Pulse: 120 bpm,
Icteric (-),Cyanosis(-), less venous pressure and volume, cold
acral, CRT>3”,
Similar Phyisical Examination: pale conjunctiva palpebra
inferior (-/-), BP: 100/70mmHg,
A DD/ Ensefalitis/Meningoencephalitis/Meningitis + Sangkaan
sepsis
P
O2 1L/i nasal canul
Spooling with NaCl 0,9% 20cc until the NGT is
clean
Diet TF 20cc/2hours/NGT  if NGT is clean
Dopamin inj is decreased  dopamin inj
10cc/hours

Follow up 23rd march 2014
Laboratory finding on 23
rd
March 2014
Complete Blood Count (CBC)
Hemoglobin (HGB) g% 11,6 10,7 – 17,1
Eritrocyte (RBC) 10
6
/ mm
3
4,53 3,75 – 4,95
Leukocyte (WBC) 10
3
/ mm
3
33,32 6,0 – 17,5
Hematocryte % 35,10 38 - 52
Trombocyte (PLT) 10
3
/ mm
3
305 217 - 497
MCV fL 77,50 93 - 115
MCH Pg 25,60 29 - 35
MCHC g% 33,00 28 - 34
RDW % 10,50 14,90 – 18,70
MPV fL 10,00 7,2 – 10,00
PCT % 0,30
PDW fL 10,5
Neutrophil % 50,00 37 - 80
Lymphocyte % 14,00 20 - 40
Monocyte % 10,00 2 – 8
Eosinophil % 0,00 1 – 6
Basophil % 0,000 0 – 1
Blood Gases Analysis
pH 7,084 7,35 – 7,45
pCO2 mmHg 73,3 38 - 42
pO2 mmHg 137 85 – 100
Bicarbonat (HCO3) Mmol/L 21,4 22 - 26
Total CO2 Mmol/L 23,7 19 - 25
Base exceess Mmol/L -9,0 (-2) – (+2)
O2 saturation % 97,1 95 - 100
Carbohydrate Metabolism
Blood glucose mg/dL 60,00 < 200
Electrolyte
Sodium (Na) mEq/L 132 135 - 155
Potassium (K) mEq/L 4,2 3,6 – 5,5
Chloride (Cl) mEq/L 103 96 - 100
RENAL
Ureum Mg/dl 44,60 <50
Creatinine Mg/dl 0,63 0,40-0,60

S
Fever (-), decreased consciousness (+), seizure (-),
O
Sensorium: GCS13 (E3V4M6), Body temperature: 36,0
o
C, Respiratory
Rate: 22x/minute,reg, ronchi (-/-), Heart Rate: 110bpm, reg,
murmur (-), Pulse: 110 bpm, Icteric (-),Cyanosis(-), adequate
venous pressure and volume, warm acral, CRT<3”, NGT (+).
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A DD/ Ensefalitis/Meningoencephalitis/Meningitis
P
elevation head 30
O
in midline position
O2 1L/i nasal canul
IVFD NaCl 0,9% 50gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H2)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Dopamin continuous inj 10cc/hours
Farmadol inj 350mg/6 hours/IV
Diet TF 20cc/2hours/NGT  if NGT is clean
Ampicillin inj 1gr/6 hours/IV (skin test)  allergy
IVFD NaCl 3% 120cc/12hours/IV should be finished in 1 hour
Follow up 24th march 2014
COMPLETE BLOOD COUNT (CBC)
Hemoglobin (HGB) g% 11.1
11.3 - 14.1
Eritrocyte (RBC) 10
6
/ mm
3
4.47
4.40 - 4.48
Leukocyte (WBC) 10
3
/ mm
3
13.49
4.5 – 13.5
Hematocryte % 33.80
37-41
Trombocyte (PLT) 10
3
/ mm
3
205
150 - 450
MCV fL 75.60
61 – 95
MCH Pg 24.80
25 – 29
MCHC g% 32.80
29 - 31
RDW % 14.00
11.6 - 14.8
MPV fL 9.40
7.0 - 10.2
PCT % 0.19
PDW fL 10.4
Neutrofil % 60.20
37 - 80
Limfosit % 26.10
20 - 40
Monosit % 11.80
2 – 8
Eosinofil % 0.00
1 – 6
Basofil % 1.900
0 – 1
Neutrofil Absolut 10
3
/mcL 8.13
2.4-7.3
Limfosit Absolut 10
3
/mcL 3.52
1.7-5.1
Monosit Absolut 10
3
/mcL 1.59
0.2-0.6
Eosinofil Absolut 10
3
/mcL 0.00
0.10-0.30
Basofil Absolut 10
3
/mcL 0.25
0-0.1
Analisa Gas Darah
pH mmHg 7.388 7.35-7.45
pCO2 mmHg 29.1 38-42
pO2 Mmol/L 152 85-100
Bikarbonat Mmol/L 17.1 22-26
Total CO2 Mmol/L 18.0 19-25
Kelebihan basa Mmol/L -7.0 (-2)-(+2)
Saturasi O2 % 99.2 95-100
ELECTROLYTE
Natrium mEq/L 133 135 – 155
Kalium mEq/L 3.6 3.6 – 5.5
Chlorida mEq/L 104 96 – 106
Kalsium mEq/L 8.2 9.2-11.0
Phospor mEq/L 3.3 3.4-6.2
Magnesium mEq/L 2.41 1.4-.17
METABOLISME KARBOHIDRAT
Glukosa Darah Sewaktu mg/dL 90 < 200
GINJAL
Ureum mg/dL 20.20 <50
Creatinine mg/dL 0.39 0.40-0.60
Asam Urat Mg/dl 4.0 <5.7
HATI
Bilirubin Total Mg/dL 0.62 <1
Bilirubin direk Mg/dL 0.40 0-0.2
Fosfatase alkali (ALP) U/L 203 <300
AST/SGOT u/L 371 <32
ALT/SGPT U/L 293 <31
Albumin g/dl 3.2 3.8-5.4
IMUNOSEROLOGI
CRP Kualitatif Positif
Procalcitonin ng/dl 29.62 <0.05
URINALISIS
URINE LENGKAP
Warna Kuning Keruh Kuning
Glukosa Negatif Negatif
Bilirubin Negatif Negatif
Keton Positif Negatif
Berat Jenis 1.020 1.005 – 1.030
pH 6.0 5 – 8
Protein Negatif Negatif
Urobilinogen Positif
Nitrit Negatif Negatif
Darah Positif Negatif
SEDIMEN URINE
Eritrosit 15-20 < 3
Leukosit 3-5 < 6
Epitel 0-1
Casts Negatif Negatif
Kristal Negatif

S
decreased consciousness (+)
O
Sensorium: GCS13 (E3V4M6), Body temperature: 37,0
o
C, Respiratory
Rate: 24x/minute,reg, ronchi (-/-), Heart Rate: 110bpm, reg,
murmur (-), Pulse: 110 bpm, Icteric (-),Cyanosis(-), adequate
venous pressure and volume, warm acral, CRT<3”, NGT (+).
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A DD/ Ensefalitis/Meningoencephalitis/Meningitis
P
elevation head 30
O
in midline position
O2 1L/i nasal canul
IVFD NaCl 0,9% 50gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H3)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Dopamin continuous inj 10cc/hours
Farmadol inj 350mg/6 hours/IV
Diet TF 20cc/2hours/NGT  if NGT is clean
Follow up 25th march 2014
ELECTROLYTE
Natrium mEq/L 133 135 – 155
Kalium mEq/L 3.6 3.6 – 5.5
Chlorida mEq/L 104 96 – 106
Kalsium mEq/L 8.2 9.2-11.0
Phospor mEq/L 3.3 3.4-6.2
Magnesium mEq/L 2.41 1.4-.17
METABOLISME KARBOHIDRAT
Glukosa Darah
Sewaktu
mg/dL 90 < 200
Laboratory Results (25th March 2014)

S
decreased consciousness (+)
O
Sensorium: GCS13 (E3V4M6), Body temperature: 37,0
o
C, Respiratory
Rate: 28x/minute,reg, ronchi (-/-), Heart Rate: 110bpm, reg,
murmur (-), Pulse: 110 bpm, Icteric (-),Cyanosis(-), adequate
venous pressure and volume, warm acral, CRT<3”, NGT (+).
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A DD/ Ensefalitis/Meningoencephalitis/Meningitis
P
elevation head 30
O
in midline position
O2 1L/i nasal canul
IVFD NaCl 0,9% 40gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H4)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Dopamin continuous inj 10cc/hours
Farmadol inj 350mg/6 hours/IV
Diet TF 20cc/2hours/NGT
R/ Lumbal Puncture
Follow up 26th march 2014

S
decreased consciousness (+)
O
Sensorium: GCS13 (E3V4M6), Body temperature: 36,3
o
C, Respiratory
Rate: 28x/minute,reg, ronchi (-/-), Heart Rate: 100bpm, reg,
murmur (-), Pulse: 100 bpm, Icteric (-),Cyanosis(-), adequate
venous pressure and volume, warm acral, CRT<3”, NGT (+).
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A Central nervous system infection ec. Encephalitis
P
elevation head 30
O
in midline position
O2 1L/i nasal canul
IVFD NaCl 0,9% 40gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H5)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Farmadol inj 250mg/6 hours/IV
Diet TF 20cc/2hours/NGT
For this moment this LP has yet to be completed because her
parents asked to be consulted to the psychiatric
Follow up 27th march 2014

S
decreased consciousness (+)
O
Sensorium: GCS13 (E3V4M6), Body temperature: 37,1
o
C, Respiratory
Rate: 26x/minute,reg, ronchi (-/-), Heart Rate: 110bpm, reg,
murmur (-), Pulse: 110 bpm, Icteric (-),Cyanosis(-), adequate
venous pressure and volume, warm acral, CRT<3”, NGT (+).
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A Encephalitis + MOD
P
elevation head 30
O
in midline position
O2 1L/i nasal canul
IVFD NaCl 0,9% 40gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H6)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Risperidone 2x1/2 tab
Farmadol inj 250mg/6 hours/IV
Diet TF 20cc/2hours/NGT
Follow up 28th march 2014

S
decreased consciousness (+)
O
Sensorium: GCS13 (E3V4M6), Body temperature: 36,3
o
C, Respiratory
Rate: 32x/minute,reg, ronchi (-/-), Heart Rate: 108bpm, reg,
murmur (-), Pulse: 108 bpm, Icteric (-),Cyanosis(-), adequate
venous pressure and volume, warm acral, CRT<3”, NGT (+).
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A Encephalitis + MOD
P
elevation head 30
O
in midline position
O2 1L/i nasal canul
IVFD NaCl 0,9% 40gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H7-H9)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Risperidone 2x1/2 tab
Farmadol inj 250mg/6 hours/IV
Diet TF 20cc/2hours/NGT
Follow up 29th-31st march 2014

S
decreased consciousness (-)
O
Sensorium: GCS14 (E3V5M6), Body temperature: 36,8
o
C, Respiratory
Rate: 24x/minute,reg, ronchi (-/-), Heart Rate: 104bpm, reg,
murmur (-), Pulse: 104 bpm, Icteric (-),Cyanosis(-), adequate
venous pressure and volume, warm acral, CRT<3”, NGT (+).
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A Encephalitis + MOD
P
elevation head 30
O
in midline position
IVFD NaCl 0,9% 40gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H11)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Risperidone 2x1/2 tab
Farmadol inj 250mg/6 hours/IV
Diet TF 20cc/2hours/oral
R/ EEG
Follow up 1st April 2014

S
decreased consciousness (-)
O
Sensorium: GCS14 (E3V5M6), Body temperature: 36,9
o
C, Respiratory
Rate: 22x/minute,reg, ronchi (-/-), Heart Rate: 92bpm, reg,
murmur (-), Pulse: 92 bpm, Icteric (-),Cyanosis(-), adequate venous
pressure and volume, warm acral, CRT<3”, NGT (+).
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A Encephalitis + MOD
P
elevation head 30
O
in midline position
IVFD NaCl 0,9% 40gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H11)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Risperidone 2x1/2 tab
Farmadol inj 250mg/6 hours/IV
Diet TF 20cc/2hours/oral
R/ Head CT-Scan
Follow up 2nd April 2014

S
decreased consciousness (-)
O
Sensorium: GCS14 (E3V5M6), Body temperature: 36,9
o
C, Respiratory
Rate: 22x/minute,reg, ronchi (-/-), Heart Rate: 96bpm, reg,
murmur (-), Pulse: 92 bpm, Icteric (-),Cyanosis(-), adequate venous
pressure and volume, warm acral, CRT<3”
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A Encephalitis + MOD
P
elevation head 30
O
in midline position
IVFD NaCl 0,9% 40gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H12)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Risperidone 1x1/2 tab
Farmadol inj 250mg/8 hours/IV
Diet MB 1800kkal+48gr protein
Advice Neurology Modul: Give the acyclovir if there is found an
enchancement from head CT Scan
Follow up 3rd April 2014

S
decreased consciousness (-)
O
Sensorium: GCS14 (E3V5M6), Body temperature: 36,8
o
C, Respiratory
Rate: 22x/minute,reg, ronchi (-/-), Heart Rate: 92bpm, reg,
murmur (-), Pulse: 92 bpm, Icteric (-),Cyanosis(-), adequate venous
pressure and volume, warm acral, CRT<3”
Thorax: Symmetrical fusiformis, retraction (-)
Abdomen: Soepel, peristaltik (+) N, liver/spleen are not palpable
A Encephalitis + MOD
P
elevation head 30
O
in midline position
IVFD NaCl 0,9% 40gtt/i/micro
Ceftriaxone inj 1g/12 hours/IV (H13)
Phenytoin inj MD 60mg/12 hours in 20cc NaCl 0,9% should be
finished in 20 minutes
Risperidone 1x1/2 tab
Farmadol inj 250mg/8 hours/IV
Diet MB 1800kkal+48gr protein
R/ LP
Follow up 4th April 2014
•These clinical manifestations occur because the viral or
bacterial enter to the brain by local, hematogen and
neural pathways to make inflamation in the brain.
Triad Encephalitis
(Fever, decreased level of
consciousness, seizure)
•These occur because the lession begin in the medial
temporal cortex and then spread along the limbic
pathways.
Signs of cerebral
dysfunction (Acute
memory disturbances
and behavioral changes)
•Do not know because the family refused to do LP Pathogens are virus
•In this patient: EEG may be match with
the generalized convulsion disease with
multifocal focus irritative and there is
general moderate-severe hypofunction
EEG
(focal slowing, spiking, and
characteristic repetitive
slow wave epileptiform
discharge)
•In this case: There is no pathologic
condition
Head CT Scan with Contrast
(abnormalities of the
temporal and/or frontal
lobes with the most
characteristic appearance of
an area of low attenuation.
Supportive treatment:
• 02 nasal canule 1l/min is given
• Diet is given
• Electrolyte Balance, Correction of acid base in blood
Causal Therapy
• Acyclovir 10mg/BW/days IV for 10-14 days was not given
Symptomatic Therapy
• Anticonvulsion: diazepam 0,3-0,5mg/BW/day is given
• To reduce oedem cerebral: dexamethasone 0,25-0,5mg/BW/day and if there is
elevating ICP, give manitol 0,5-2gr/BW IV 8-12 hours but this was not given
• Farmadol 250mg/6h IV
Mental Organic Disorder therapy
• Risperidone is given
Antibiotic: Ceftriaxone inj 1g/12h/ IV
•This paper reports a case of a 8 years 9 monts girl
diagnosed with Encephalitis and Mental organic
disorder

•A comprehensive work up has not been done to
confirm the diagnosis of Encephalitis

•The treatment for this patient includes the
anticonvulsant (diazepam) , Farmadol as
antipyretic given when needed, O
2
consider
the airway protection, Antibiotic (ceftriaxone) to
prevent secondary infection, and adequate diet.
THANK YOU