A Clinical case of Possible Rabies Encephalitis

There are many clinical cases which can only be provisionally diagnosed based on the clinical findings & limited supportive Investigative reports. Dr. Saumya H Mittal presents a case of Rabies Encephalitis in which MRI was the only supportive investigation to provisionally diagnose the case. Share your views on this case Follow us for more such updates!

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An Excellent clinical presentation of a case of Possible Rabies encephalitis by Dr Saumya H Mittal . Neurology has always been a tough subject for general practitioners - but it was a perfect way - how to approach a case of Neurology with step by step clinical examination. Although- there was only history of unprovoked stray dog bite with no hydrophobia - it was difficult to diagnose clinically .But MRI findings made it easier - although differentiation from Japanese encephalitis was difficult as at 6 years of age it was possible . I will brief about the MRI FINDINGS SEEN IN RABIES ENCEPHALITIS- main imaging feature is an increase in T2 signal (best seen on FLAIR) in the affected parts of the brain and spinal cord, with a predilection for grey matter structures. As the disease progresses, swelling becomes more marked and petechial haemorrhages occur, as well as contrast enhancement. The distribution of imaging changes, naturally, depends on the type of involvement. In classic rabies encephalitis, increased T2 signal has a predilection for the basal ganglia,thalami, hypothalami,brainstem, limbic system, and spinal cord as well as the frontal and parietal lobes In paralytic rabies, the involvement of the spinal cord and medulla are more pronounced, although no specific imaging features exist to allow differentiation from the classic encephalitic form. AS PROGNOSIS IN RABIES ENCEPHALITIS IS VERY POOR - because no definite specific treatment is available and only few survivors are seen . Thanks Dr Soumya H Mittal for enlightening us

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Rabies encephalitis is one of the oldest and deadliest communicable disease known to man. Human Rabies present with Two forms ,encephalitis and paralytic forms. Encephalitis form is more common and is characterized initially by hyperactivity which soon progressed to episodes of fluctuating conciousness, phobic spasm,aerophobia,hydrophobic triggered by puffs of air and sounds ,water are the hall mark of Rabies encephalitis. DD of Rabies encephalitis include Japanese B encephalitis and other encephalitis. The predilection of Rabies for brain stem,thalamus and hippocampus,the absence of hemorrhage and the absence of enhancement during acute phase of the disease may help in differentiating it from JapaneseB encephalitis and other viral encephalitis.

Excellent case presentation of possible Rabies Encephalitis after h/o dog bite with scar or animal bite scar. And d/d of encephalitis Rabies/ Japanese,/ herpes simplex/enterovirus/chandipura virus/ Meningitis.... Congratulations Dr.Saumya Mittal.

Excellent history taking from no clue to final diagnosis utmost importance given to each and every possible clue from different tests ultimately after step by step ruling out simple fever , meningitis, different types encephalitis reaching a diagnosis of Rabies encephalopathy on the basis MRI finding in Baal ganglia thymus brain stem and lambic system Congratulations Dr Saumya H Mittal for hard work

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

WONDERFUL CASE PRESENTATION SIR AND VERY KNOWLEDGEABLE FOR PERSONS LIKE ME...... ACTUALLY, SOMYA SIR., THE DISEASE WAS OUT OF MIND....... A VERY IMPORTANT CASE FOR ALL OF US........ SINCERELY SIR..... RAJESH GOPAL...... CHARAN VANDHNA SIR......

I TOTALLY AGREE WITH THIS PIST THAT MANY CLINICAL CASES CAN BE DIAGNOSED WITH THEIR RESPECTIVE CLINICAL FINDINGS AND MINIMAL INVESTEGATIONS EVEN IF WE HAVE GALAXY OF INVESTEGATIVE PRICEURES ADVIABLE THSESE DAYS WE SHOULD NEITHER UNDER OR OVERUSE THEM I WILL GIVE A SIMPLE EXAMPLE EVERY CASE OF HEAD ACHE DOES NOT NEED CBT SCAN

YES NICELY WRITTEN PIST THAT IN MOST OF SITUATIONS MANY CLINICAL CASES ARE AND CAN BE DIAGNOSED BY ONLY RESPECTIVE CLINICAL CASES AND MINIMAL INVESTEGATIONS WE SHOULD NEITHER OVER OR UNDERUSED RECENT INVESTEGATIVE PROCEDURES SO THE KEY IS CLINICAL EXAMINATION IS VERY ESSENTIAL THAN UNNESSARY LONG LIST OF INVESTEGATIONS

Yeah Rabies encephalopathy is fast developing eventually ending in death with in 48hrs to 72 hrs of diagnosis inspite of any treatment modalities

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Nicely complied and comprehensive observations and informative video. Thanks for elobrating and sharing.

Thanks Dr Dinesh Gupta
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