The Nipah virus (Nv) is a newly recognised zoonotic virus that has been linked to numerous outbreaks characterised by significant mortality rates, primarily occurring in regions of South and Southeast Asia. Nv is known to cause encephalitis and systemic vasculitis, and in certain cases, it is also associated with respiratory illnesses. Fruit bats serve as the primary reservoir of Nv, which can be spread through zoonotic means either directly or through an intermediary host, such as a pig or horse. Numerous investigations have been conducted to investigate the viral mechanism behind illness progression and its broader pathophysiology. Nevertheless, it is imperative to comprehend the pathophysiology and dynamics of the disease in order to facilitate the development of treatment interventions and vaccinations. Therefore, this review aims to present a thorough and up-to-date analysis of the evolving comprehension of the pathogenesis of Nv.