Brain infections such as meningitis and encephalitis are life-threatening emergencies requiring early recognition and treatment. These infections can be caused by bacteria, viruses, tuberculosis, or autoimmune processes. Delay in diagnosis can lead to irreversible brain damage, seizures, coma, or even death. At AIH, we frequently manage complex cases involving neuro infections with a multidisciplinary approach.

Understanding Meningitis

• Meningitis is the inflammation of the meninges (the protective layers around the brain and spinal cord).
• Bacterial meningitis is more severe and demands urgent antibiotic therapy.
• Common bacterial causes:
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Haemophilus influenzae (HiB)
• Viral meningitis tends to be milder, often caused by enteroviruses.

Symptoms:

• High-grade fever
• Severe headache
• Neck stiffness
• Nausea, vomiting
• Sensitivity to light (photophobia)
• Altered mental status in severe cases

Understanding Encephalitis

• Encephalitis is the inflammation of brain tissue itself.
• Most often caused by viruses such as:
  • Herpes Simplex Virus (HSV)
  • Japanese Encephalitis Virus
  • Dengue virus
• Other causes include autoimmune encephalitis, especially in young patients.

Symptoms:

• Fever and confusion
• Behavioral changes or hallucinations
• Seizures
• Focal neurological deficits
• Coma in severe cases

Tuberculous Meningitis

• Common in Pakistan due to high TB prevalence.
• Often has a gradual onset with symptoms such as:
  • Persistent low-grade fever
  • Night sweats
  • Chronic headache
  • Vomiting
  • Drowsiness
• Diagnosis requires high suspicion and specialized CSF testing.
• Early anti-tubercular therapy and steroids are critical for survival.

Autoimmune Encephalitis

• Caused by antibodies attacking the brain (e.g., anti-NMDAR, LGI1).
• Often misdiagnosed as psychiatric illness or viral encephalitis.
• Common in young adults or children.
• Responds well to steroids, IVIG, or plasma exchange.
• Early diagnosis can reverse symptoms dramatically.

Diagnostic Evaluation

• Lumbar puncture (spinal tap) is essential:
  • Measures CSF pressure
  • Analyzes cell count, glucose, protein
  • PCR to detect viral or TB DNA
• Neuroimaging (MRI) helps identify inflammation or abscess.
• EEG useful in encephalitis with seizures or altered awareness.
• Blood cultures, TB screening, autoimmune antibody testing may also be required.

Emergency Red Flags

• Seizures or status epilepticus
• Rapid loss of consciousness
• Severe headache with vomiting
• Focal weakness or paralysis
• Persistent fever with altered behavior
• Complications
• Post discharge care
• Follow ups
• Reoccurence possibility

Treatment Principles

• Start empirical treatment early — do not wait for full test results.
• For bacterial meningitis:
  • IV antibiotics (e.g., ceftriaxone + vancomycin)
  • Dexamethasone may reduce complications
• For viral encephalitis:
  • Immediate IV acyclovir if HSV suspected
  • Supportive care (hydration, fever control, seizure management)
• For TB meningitis:
  • Full anti-TB drug regimen
  • Corticosteroids for inflammation
• For autoimmune encephalitis:
  • High-dose steroids, IVIG or plasmapheresis
  • Treat underlying tumor if present (e.g., ovarian teratoma in NMDAR encephalitis)

Prognosis and Recovery

• Early treatment improves survival and outcome.
• Some patients recover fully; others may have long-term effects:
  • Memory problems
  • Epilepsy
  • Weakness or behavioral issues
• Tuberculous and HSV encephalitis carry higher risks of complications.
• Autoimmune encephalitis, when treated timely, has a very favorable outcome.

Prevention Strategies

• Vaccination is key:
  • HiB, pneumococcal, and meningococcal vaccines prevent bacterial meningitis.
  • Japanese encephalitis vaccine in endemic areas.
• Hygiene and mosquito control reduce viral encephalitis risk.
• TB control programs essential in our region.
• Raising awareness of autoimmune encephalitis is crucial.

Take Away Message

• Brain infections are neurological emergencies.
• Do not ignore fever with confusion or severe headache — it could be life-threatening.
• At AIH, we are equipped with modern diagnostics and ICU support for treating these conditions.
• Early consultation with a neurologist can save lives and prevent disability.

For any such symptoms or concerns, timely evaluation by a neurologist is essential. At AIH, we provide 24/7 neurological care with advanced diagnostics, ICU support, and personalized treatment protocols.