ACUTE FEBRILE ENCEPHALOPATHY DIAGNOSTIC AND PROGNOSTIC DETERMINANTS
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Keywords
Acute febrile encephalopathy, viral meningoencephalitis, septic encephalopathy, Glasgow Coma Scale, cerebrospinal fluid analysis.
Abstract
Background: Acute febrile encephalopathy (AFE) presents a diagnostic and therapeutic challenge in the emergency department, especially in regions with diverse infectious profiles. This study aims to identify the clinical, laboratory, and radiological features of AFE and evaluate the diagnostic and prognostic determinants in a tertiary care center.
Methods: A prospective, hospital-based study was conducted at Government Medical College Srinagar from April 2021 to March 2022. All adult patients with acute febrile encephalopathy were included. Diagnostic workups included complete blood count, metabolic profile, liver function tests, chest radiography, and cerebrospinal fluid (CSF) analysis in consenting patients.
Results: A total of 91 patients (65.9% male, mean age 57.1 ± 14.91 years) were included. The most common comorbidities were hypertension (39.6%) and diabetes mellitus (29.7%). The primary presenting symptoms were fever, altered sensorium, headache (57.1%), and nuchal rigidity (41.8%). CNS infections were identified in 63.7% of cases, with viral meningoencephalitis (31.9%) being the most common etiology. Mortality was 11%, with higher rates observed in patients over 60 years (16.3%) and those with comorbidities. Mortality was significantly higher in patients with a Glasgow Coma Scale (GCS) score <10 (20.6% vs 5.3%, p<0.05). In CSF analysis, lymphocytic predominance was suggestive of viral etiology, while neutrophilic leukocytosis pointed to sepsis-associated encephalopathy.
Conclusions: CNS infections, especially viral meningoencephalitis, are the predominant cause of AFE, associated with higher mortality. Age above 60 years, hypertension, and low GCS scores were significant prognostic factors. Early lumbar puncture and timely initiation of antimicrobial therapy are essential for improving outcomes. Further studies with larger sample sizes are recommended to validate these findings.
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Dr. Mohammad Manzar Baig
Postgraduate Scholar, Department of Emergency Medicine, Government Medical College, Srinagar, Jammu and Kashmir
Dr. Judith Mattakkal Jose
Postgraduate Scholar, Department of Emergency Medicine, Government Medical College, Srinagar, Jammu and Kashmir
Dr. Aabid Hussain Dar
Postgraduate Scholar, Department of Emergency Medicine, Government Medical College, Srinagar, Jammu and Kashmir
Dr. Kamal A. Johnson
Postgraduate Scholar, Department of Emergency Medicine, Government Medical College, Srinagar, Jammu and Kashmir