Delay in Diagnosis & Treatment of Encephalitis (Brain Swelling, Inflammation)

Evaluate breaches in the standard of care of Delay in Diagnosis & Treatment of Encephalitis (Brain Swelling, Inflammation)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Altered level of consciousness/coma
    New onset of seizures
    New focal neurologic deficit
    Persistent fever
    Symptoms not elicited/recognized
    Answer unknown
    Why is this important?
    Acute encephalitis, also known as meningo-encephalitis and encephalomyelitis, constitutes a medical emergency. It is an acute infection of brain parenchyma characterized by fever, headache, and an altered level of consciousness.
    (2007) 18 ECANCC 2 107-116

  • Were the patient’s airway, breathing, circulation and glucose levels stabilized? Why is this important?
    Answer this question
    Upon arrival, the initial evaluation must begin with assessment of airway, breathing, and circulation. Hypoxia, hypotension, fever, and seizures must be promptly treated to reduce the likelihood of secondary brain injury.
    (2013) 29 ECRICC 2 259-277

  • What was the patient’s Glascow Coma Score? Why is this important?
    Answer this question
    The Glasgow coma scale is an objective method of following the patient's neurologic status. The Glasgow coma scale assesses a patient's eye, verbal, and motor responsiveness.
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  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Risk factors are useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
    Click here for additional information at MD Consult.com

  • Was a physical examination including a neurological evaluation performed? Why is this important?
    Answer this question
    A physical examination must be performed with particular attention to level of consciousness, airway protective reflexes, seizure activity, and physical clues that may point to a particular cause.
    (2013) 29 ECRICC 2 259-277

  • Which of the following interventions were employed to stabilize the patient? (Choose all that apply) Why is this important?
    Answer this question
    The history and presentation alone are an adequate basis on which to commence therapy with acyclovir, as the morbidity associated with delayed treatment in particular with HSV, is so dire.
    (2007) 18 ECANCC 2 107-116

  • Which of the following imaging studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    Imaging is now an established part of the care of patients with suspected encephalitis.
    (2007) 18 ECANCC 2 107-116

  • Was a lumbar puncture performed to analyze the cerebrospinal fluid? Why is this important?
    Answer this question
    A lumbar puncture must be preceded by neuro-imaging, CT scan or MRI, to check for raised intracranial pressure. It is an essential investigation in the management of patients with suspected encephalitis, both to confirm the diagnosis and to rule out other causes.
    (2012) 64 JNLINF 4 347-373

  • Which of the following laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    Routine laboratory studies can provide important clues to diagnosis.
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  • Was a human immunodeficiency virus (HIV) test performed? Why is this important?
    Answer this question
    Encephalopathy is the most common central nervous manifestation of the human immunodeficiency virus infection.
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  • Was an electroencephalogram performed? Why is this important?
    Answer this question
    An electroencephalogram is a sensitive diagnostic investigation for brain dysfunction.
    (2013) 29 ECRICC 2 259-277

  • Which of the following etiologies of encephalitis were identified? Why is this important?
    Answer this question
    Despite an extensive work-up, it is often not possible to identify the cause of the symptoms.
    (2013) 29 ECRICC 2 259-277

  • Were antibiotics administered? Why is this important?
    Answer this question
    Empiric antibiotic treatment with ceftriaxone (or another third-generation cephalosporin such as cefotaxime) and vancomycin must be initiated immediately to provide coverage for streptococcus pneumoniae and neisseria meningitidis.
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  • Were repeat lumbar punctures performed? Why is this important?
    Answer this question
    If an initial lumbar puncture is non-diagnostic, a second lumbar puncture may be performed 24–48 hours later.
    (2012) 64JNLINF 4 347-373

  • Was the acyclovir stopped appropriately? Why is this important?
    Answer this question
    When the initial cerebrospinal fluid reveals an alternative diagnosis, such as bacterial infection, the acyclovir can be safely stopped. Acyclovir treatment must not be stopped on the basis of a single negative cerebrospinal fluid polymerase chain reaction only, when herpes simplex virus encephalitis is still suspected clinically.
    (2012) 64 JNLINF 4 347-373

  • Was the patient monitored throughout the hospital stay? Why is this important?
    Answer this question
    Patients need to be frequently evaluated to prevent severe complications such as hyponatremia, seizures, brain edema, and herniation. Comatose patients must receive aggressive care to prevent decubiti, contractures, and deep vein thrombosis. Close attention must be paid to weights, input/output, and serum electrolytes.
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  • Which of the following rehabilitation modalities were prescribed? (Choose all that apply) Why is this important?
    Answer this question
    A broad and comprehensive approach to both assessment and rehabilitation is necessary, with input from specialists in neuropsychology, neuropsychiatry, speech and language therapy, neuro-physiotherapy, and occupational therapy.
    (2012) 64 JNLINF 4 347-373

  • Was patient education provided? Why is this important?
    Answer this question
    Patients diagnosed with encephalitis and those supporting them require extensive information regarding the disease process, isolation techniques, treatment therapies, and prevention.
    (2012) 64 JNLINF 4 347-373

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise. Regular check-ups ensure that changes in health are quickly assessed and remedied.
    Click here for additional information at ClinicalKey.com