ICNC Abstracts, ICNC 2018

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Microbiological diagnostic challenges in a seasonal cluster of Rhombencephalitis
smilu mohanlal, Lokesh lingappa, Ramesh Konanki, Nikit Milind Shah, Srikanth Domala, Ashwini Mohan, Ravi verma

Last modified: 2018-09-09


Introduction: Rhombencephalitis refers to the inflammatory diseases affecting the Hindbrain. There are various etiological factors for rhombencephalitis, however etiological factors and outcomes would vary with different age groups.

Methodology: Retrospective chart review from January 2017- May 2018

Results: 10 patients  admitted with the clinical or radiological features of rhombencephalitis. Age of presentation  from 11months-11years(M:F-9:1). The common clinical manifestation at  time of presentation was fever(8/10), hypoventilation(7/10). others include seizures(2/10), paresis(6/10), encephalopathy(4/10), bulbar dysfunction (3/10), ophthalmoplegia (4/10 ), cranial nerve VII involvement (2/10), quadriparesis in (4/10), paraparesis in (1/10) and monoparesis in (2/10). (2/10) had cardiac dysfunction who were initially managed as myocarditis. CSF pleocytosis in (4/10). MRI features of rhombencephalitis with myelitis in (6/10)  rhombencephalitis with cortical involvement (2/10), only rhombencephalitis (2/10). (8/10) required intensive care, (4/10) ventilation, duration ranged from 5-45 days. Tracheostomy in (3/10) decanulated over  a period of (30-90 days). Lyme serology was positive in 1 patient. Paired serum and CSF showed elevated rabies antibody titres in 1 patient.

All were discharged with favourable neurological outcome with improved sensorium, muscle power. Duration for recovery ranged from (5 days- 90 days).

Conclusion: Clinical presentations varied from fever with encephalopathy to paresis with no encephalopathy. All had survival and favorable neurological outcome including child with Rabies who has survived and is ambulant. Seasonal clustering of cases between May- September 2017 was noted .In spite of an extensive evaluation including viral PCR, serum NMO antibodies, the etiology remained unclear in 8 patients



Rhombencephalitis;Rabies;Lyme Disease

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