Dr Varun Manjunath Neurologist

Altered Sensorium - Meningitis, Encephalitis, Encephalopathy

Altered sensorium refers to changes in mental status, consciousness, or awareness. Conditions such as meningitis, encephalitis, and encephalopathy can all lead to altered sensorium, although they have different causes and characteristics:

1. Meningitis: Meningitis is an inflammation of the protective membranes covering the brain and spinal cord (meninges). It is often caused by an infection, typically bacterial or viral. In meningitis, altered sensorium may manifest as confusion, altered level of consciousness, lethargy, or coma. Other symptoms may include fever, headache, neck stiffness, nausea, vomiting, and sensitivity to light.

2. Encephalitis: Encephalitis is inflammation of the brain tissue itself, usually caused by a viral infection. In addition to symptoms similar to meningitis, encephalitis can cause altered sensorium, seizures, focal neurological deficits (such as weakness or paralysis), hallucinations, and behavioral changes. Severe cases may result in coma or even death.

3. Encephalopathy: Encephalopathy refers to a broad term for brain dysfunction that can have various causes, including metabolic disturbances, infections, toxins, or lack of oxygen to the brain. In encephalopathy, altered sensorium may present as confusion, disorientation, personality changes, memory impairment, or impaired judgment. Symptoms may range from mild to severe, depending on the underlying cause and duration of the condition.

Diagnosis of these conditions typically involves a thorough medical history, physical examination, neurological assessment, and diagnostic tests such as blood tests, imaging studies (such as MRI or CT scans), lumbar puncture (spinal tap) to analyze cerebrospinal fluid, and electroencephalography (EEG) to evaluate brain function.

Treatment depends on the underlying cause of altered sensorium:

• Meningitis: Bacterial meningitis is a medical emergency and requires prompt treatment with antibiotics. Viral meningitis may resolve on its own with supportive care, such as rest, fluids, and pain management. Vaccines are available to prevent some types of bacterial meningitis.

• Encephalitis: Treatment of encephalitis focuses on managing symptoms and providing supportive care. Antiviral medications may be used if the encephalitis is caused by a virus. Supportive care may include anticonvulsants for seizures, corticosteroids to reduce inflammation, and treatment of complications such as respiratory support or intracranial pressure management.

• Encephalopathy: Treatment of encephalopathy depends on the underlying cause. For example, correcting metabolic disturbances, treating infections, removing toxins, and addressing any contributing medical conditions (such as liver or kidney failure) may help improve symptoms of encephalopathy.

Prompt recognition and treatment of these conditions are essential to prevent complications and improve outcomes. If you or someone you know is experiencing altered sensorium or symptoms suggestive of meningitis, encephalitis, or encephalopathy, seek medical attention immediately.