Abstract Details

Any brain inflammation caused by infection, usually with a virus or a primary autoimmune process, is called encephalitis. Although encephalitis, by definition, involves the brain parenchyma, it may affect the meninges as well, which is termed ‘meningoencephalitis.’ From an epidemiological and pathophysiologic perspective, encephalitis differs from meningitis, though both can coexist in clinical evaluation.

This study aimed to delineate the clinical profile, laboratory parameters, and radiological features of patients with meningoencephalitis and assess their outcome predictors. 

This prospective, observational, and descriptive study was conducted from July 2021 to March 2023. Patients satisfying the case definition of ‘meningitis’ and ‘encephalitis’ were enrolled after due informed consent. Mortality and morbidity [by modified Rankin score (mRS)] were noted at discharge, one month, and three months. 

Out of 102 patients recruited, amongst infectious causes of meningoencephalitis, 28 (27.5%) were viral, 11 (10.8%) pyogenic, 32 (31.5%) tubercular, 4 (3.9%) each rickettsial, atypical bacteria, fungal, and 3 (2.9%) were parasitic. Among non-infectious etiologies, 12 (11.8%) were antineuronal antibody-mediated, 3 (2.9%) were systemic inflammatory, and one (1%) had carcinomatous meningitis. CSF analysis showed the highest protein content (336.82±251.26 mg/dl) and cell count (476.73±999.16) in pyogenic. CSF glucose was lowest in tubercular (38.30±20.29 mg/dl). On imaging, leptomeningeal enhancement was found in 89.7% of tubercular and limbic involvement more often in viral (38.5%) etiology. Overall mortality was highest in fungal and rickettsial (75% each). Fever, altered sensorium, speech disturbances, neck stiffness, albumin, total leukocyte count, ESR, CRP, kidney, and liver function tests showed significant association with mortality.

Tubercular was the most common cause in our centre in Western India. The atypical bacterial, parasitic, and systemic inflammatory groups had the best recovery at discharge. However, tubercular, atypical bacterial, and antineuronal antibody-mediated meningoencephalitis was associated with a significant change in mRS score over time.