A 17-Year-Old Boy Successfully Treated for Headaches and Seizures Caused by Purulent Encephalitis

Disclaimer: This article is intended solely for educational and informational purposes. Patient details have been altered to protect privacy.

Overview of the Case

This case involves a 17-year-old male who was admitted to the hospital following a seizure episode. In the evening, he suddenly experienced a seizure marked by loss of consciousness, limb spasms, and foaming at the mouth, lasting approximately ten minutes before subsiding. Following a series of medical evaluations, he was diagnosed with purulent encephalitis, a form of bacterial brain infection. Prompt medical treatment led to significant improvement in his headache symptoms, no recurrence of seizures, and a full recovery upon discharge.

Patient Profile

Gender: Male
Age: 17 years
Diagnosis: Purulent Encephalitis
Treatment Facility: Jixi People's Hospital
Admission Date: April 2022
Therapeutic Approach: Intravenous administration of Ceftriaxone Sodium, Xuebijing Injection, Methylprednisolone Sodium Succinate, Compound Mannitol Injection, and Phenobarbital Sodium Injection.
Duration of Treatment: 21 days of inpatient care followed by one month of outpatient follow-up.
Outcome: Gradual symptom relief and complete recovery.

Initial Assessment and Presentation

The patient was admitted due to a sudden seizure episode. Upon arrival at the hospital, the seizure had ceased, but he still experienced significant headache, fatigue, and joint pain. Initially, a seizure disorder like epilepsy was suspected.

According to the family, the patient had no prior history of seizures. However, approximately one week before the seizure, he was caught in the rain on his way home from school. Since then, he had been experiencing symptoms like coughing, yellow phlegm, runny nose, and fever, with a maximum temperature of 38.0°C. Due to a busy academic schedule, he had not sought medical attention and had self-medicated with over-the-counter cold and fever medications. Over the past two to three days, he began showing signs of fatigue, headaches, and vomiting. By the evening of the seizure incident, he collapsed with convulsions at school. Based on this history, I suspected the seizure might be secondary to an underlying condition, and bacterial encephalitis was the primary concern.

Upon physical examination, his body temperature was 39.0°C, and lung auscultation revealed dry and wet rales. Neurological assessment showed neck stiffness and a positive Kernig's sign. Further diagnostic tests were conducted: blood tests showed elevated white blood cell count (15.13×10^9/L), high neutrophil percentage (94.34%), and elevated inflammatory markers like procalcitonin (13.89 ng/mL) and C-reactive protein (186.76 mg/L). Brain CT showed no abnormalities, but lung CT revealed inflammatory changes in the lower left lobe. An EEG detected spike waves. These findings strongly indicated encephalitis as the cause of his headaches and seizure activity, leading to hospitalization.

Treatment Process

After explaining the situation to the family, they were understandably anxious. I reassured them that, with early and appropriate treatment, bacterial encephalitis could be effectively managed. They agreed to proceed with the treatment plan. A lumbar puncture was performed, and the cerebrospinal fluid (CSF) analysis revealed elevated protein levels (2394 mg/L), low glucose (0.03 mmol/L), and increased white blood cell count (500×10^6/L), confirming the diagnosis of bacterial meningitis.

To address the infection, we initiated treatment with intravenous Ceftriaxone Sodium, a third-generation cephalosporin with strong blood-brain barrier penetration. Additionally, Xuebijing Injection was administered to support anti-inflammatory and antiviral effects. Given the acute nature of the infection, Methylprednisolone Sodium Succinate was used to reduce cerebral inflammation and edema. To manage increased intracranial pressure, Compound Mannitol Injection was administered intravenously. Finally, Phenobarbital Sodium was given intramuscularly to control seizure activity and provide symptomatic relief.

Positive Treatment Outcomes

After 21 days of comprehensive antibiotic therapy and supportive care, the patient's condition improved significantly. His fever subsided, seizures did not recur, and his overall mental state and headache symptoms improved. During treatment, the patient expressed concern about falling behind in his studies due to hospitalization. I encouraged him to prioritize rest, nutrition, and emotional well-being, as these are essential for recovery and for performing well in high-stakes exams like the college entrance exam. He followed medical advice diligently and was eventually discharged in good health.

Post-Treatment Care and Recommendations

Although the patient recovered well, one month of outpatient follow-up was required. I advised the family to ensure he received adequate nutrition, as immune function is significantly compromised following purulent encephalitis. A diet rich in protein and vitamins was recommended to support immune recovery. Hydration was also emphasized, as proper fluid intake helps boost immunity and reduces the risk of complications like septic shock. The patient was also advised to avoid overexertion and prioritize rest, as maintaining good health is crucial for academic performance.

Clinical Insights and Patient Education

Purulent encephalitis, a type of bacterial brain inflammation, can occur at any age and is often preceded by infections such as colds, pneumonia, or gastroenteritis. In this case, the patient had untreated flu-like symptoms a week before the seizure, which likely allowed bacteria to invade the nervous system, leading to serious complications.

If symptoms like fever, cough, diarrhea, or persistent headaches occur for an extended period, prompt medical attention is essential. The prognosis of encephalitis is closely tied to the type of pathogen, the patient's immune status, and the timeliness of effective antibiotic treatment. Delayed treatment can lead to long-term consequences such as cognitive impairment or epilepsy. Early diagnosis and appropriate medical intervention remain the most effective strategies for ensuring a full recovery.