Recognise the emergency
Fever with headache, neck stiffness, photophobia, vomiting, confusion or drowsiness suggests meningitis or encephalitis. A non-blanching rash, seizures, focal weakness, reduced consciousness or shock are red flags. Bacterial meningitis can be fatal within hours and needs emergency hospital treatment.
Do not wait for a routine clinic appointment. Go to the nearest emergency department. If the person is drowsy, having a seizure, cannot be woken or has difficulty breathing, call an ambulance.
- Fever with severe headache and neck stiffness
- Confusion, drowsiness or reduced consciousness
- New seizure or focal weakness
- Non-blanching rash, cold hands or shock
- Headache after head injury, surgery or a shunt
Related: Neurology → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Causes seen in Nepal
Bacterial meningitis is caused by organisms such as Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae. Tuberculous meningitis is an important cause in Nepal and often presents subacutely with headache, low-grade fever, vomiting and cranial nerve palsies.
Viral meningitis and encephalitis, including herpes simplex encephalitis, Japanese encephalitis and enterovirus, are also seen. Dengue, scrub typhus, leptospirosis and other monsoon infections can cause neurological involvement. Fungal infection and brain abscess are more likely in people who are immunocompromised.
Hospital assessment
The acute assessment includes blood cultures, blood counts, glucose, kidney and liver tests, and imaging. A lumbar puncture is performed when it is safe to do so. CT or MRI is done first if there are focal neurological signs, seizures, reduced consciousness, immunocompromise or signs of raised intracranial pressure.
Cerebrospinal fluid is examined for cells, protein, glucose, organisms and, when indicated, TB testing and viral PCR. EEG helps if there are seizures or unexplained confusion. Treatment with antibiotics or antivirals is started promptly and is not delayed for test results when the clinical picture is suspicious.
Recovery and long-term follow-up
After the acute infection, some people have persistent headache, fatigue, memory or concentration problems, hearing loss, dizziness, weakness, cranial nerve palsy, seizures or hydrocephalus. TB meningitis needs prolonged treatment and monitoring for complications such as stroke, hydrocephalus and vision or hearing loss.
Dr. Yadav reviews neurological recovery, seizure risk, imaging and rehabilitation needs, and coordinates with infectious disease, ENT, audiology, physiotherapy and neurosurgery when required.
Access and booking
Appointments are at Kathmandu Neurology Clinic & Cognitive Center, 117 Lal Durbar Marg, Kathmandu, opposite Yak & Yeti Hotel. Call +977-9747736624 or use /book-appointment. Bring prior reports, imaging and a medication list.