Autoimmune encephalitis

Elizabeth Premarani*

Assistant Nursing Superintendent, Kauvery Hospital, Salem, Tamil Nadu

*Correspondence

Abstract

Autoimmune encephalitis is an inflammatory disorder of the brain caused by an abnormal immune response against neuronal tissues. It commonly presents with seizures, altered sensorium, behavioural abnormalities and neurological deficits. This case study describes a 4-year-old male child admitted with fever, multiple episodes of seizures, neck stiffness, vomiting, altered consciousness and behavioural abnormalities. Clinical evaluation and investigation supported the diagnosis of autoimmune encephalitis. The child was managed with anti-convulsant, supportive therapy, immunotherapy and close neurological monitoring. Early diagnosis and multidisciplinary management improved the child’s condition and reduced complications.

Key words: Autoimmune encephalitis; Neck stiffness; Pediatric autoimmune encephalitis

Introduction

Auto immune encephalitis is a serious neurological condition in which the body’s immune system attacks brain cells, causing inflammation. It can affect children and adults and often presents with symptoms such as fever, seizures, irritability. abnormal movements, altered mental status and behavioural changes. Early recognition and treatment are important to prevent permanent neurological damage. Pediatric autoimmune encephalitis requires coordinated medical and nursing care for successful recovery.

Case Presentation

  • Cold and cough for 3 days
  • High-grade fever for 2 days
  • Irritability and neck stiffness for 2 days
  • Loose stools (2 episodes)
  • Vomiting (2-3 episodes)
  • Two episodes of seizures associated with stiffening of joints, up rolling of eyes, loss of consciousness, and altered sensorium following seizures.

Past history

  • History of febrile illness 2 months earlier lasting 7 days.
  • Similar illness noted in family members.
  • No previous seizure episode.

Clinical finding

General examination

  • Fever present
  • Irritability observed
  • Altered level of consciousness
  • Behavioural abnormalities present;.

Neurological findings

  • Seizure episodes
  • Neck stiffness
  • Dyskinesia (resolved later)
  • Altered sensorium
  • Behavioural disturbances.

Investigations

  • Complete Blood Count (CBC) to assess infection/inflammation.
  • Serum Electrolytes: To identify metabolic imbalance.
  • Lumbar Puncture / CSF Analysis – To detect infection/ inflammation.
  • MRI Brain – To identify brain inflammation.
  • EEG – (Electroencephalogram) – To assess seizure activity.
  • Autoimmune Antibody Testing – To confirm autoimmune encephalitis.
  • Blood Culture and viral markers – To rule out infections causes.

Diagnosis: Autoimmune encephalitis induced altered sensorium, dyskinesia and behavioural abnormalities

Management

Medical management

  • Anti-convulsants for seizure control.
  • Intravenous fluids to maintain hydration.
  • Antipyretics for fever management.
  • Immunotherapy:
  • Steroids
  • Intravenous Immunoglobulin (IVIG)
  • Monitoring of neurological status.
  • Nutritional support.

Supportive management

  • Oxygen therapy if required.
  • Maintenance of airway during seizures.
  • Prevention of aspiration.
  • Psychological support for patients.

Nursing aspects

Nursing assessment

  • Monitor level of consciousness.
  • Observe seizure activity.
  • Assess vital signs regularly.
  • Monitor intake and output.
  • Assess behavioural changes.

Nursing diagnosis

  • Ineffective cerebral tissue perfusion related to brain inflammation.
  • Risk for injury related to seizure.
  • Hyperthermia related to infection/inflammation.
  • Imbalanced nutrition related to vomiting and illness.
  • Anxiety among parents related to child’s condition.

During seizure

  • Place child in lateral position.
  • Maintain airway patency.
  • Do not insert objects into month.
  • Administer anticonvulsants as prescribed.
  • Record duration and characteristics of seizures.

General care

  • Maintain Hydration and Nutrition.
  • Provide fever management.
  • Ensure safe environment.
  • Monitor neurological status frequently.
  • Administer medication on time.
  • Maintain infection control measures.

Psychological support

  • Educate parents about disease condition.
  • Reduce parental anxiety through counselling.
  • Encourage family participation in care.

Evaluation

  • Seizure controlled.
  • Improvement in sensorium.
  • Fever reduced.
  • Behavioural abnormalities monitored.
  • Child stabilized without complication

Conclusion

This child presented with Autoimmune encephalitis, a neurological condition, with fever, seizures, altered sensorium and behavioral abnormalities. Early diagnosis and appropriate treatment hastened recovery and prevented complications. In this child, dyskinesia had resolved but behavioral abnormalities are still present

Reference

  1. Garg D, Mohammad SS, Sharma S. Autoimmune Encephalitis in Children
  2. Indian Pediatrics Cellucci T, Van Mater H, Graus F, et al. Clinical approach to the diagnosis of autoimmune encephalitis in the pediatric patient.

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