Pitfalls associated with the diagnosis of herpes simplex encephalitis
| Autor: | Josef G. Heckmann, Ivana Vachalova, Leila Kyavar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Pediatrics Acyclovir Status epilepticus medicine.disease_cause cerebrospinal fluid lcsh:RC321-571 030218 nuclear medicine & medical imaging 03 medical and health sciences consciousness disturbance 0302 clinical medicine Cerebrospinal fluid atypical course of disease medicine Case Series Medical diagnosis lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry medicine.diagnostic_test business.industry Lumbar puncture General Neuroscience herpes simplex encephalitis medicine.disease herpes simplex virus Surgery Herpes simplex virus Delirium Neurology (clinical) medicine.symptom Differential diagnosis business 030217 neurology & neurosurgery Encephalitis |
| Zdroj: | Journal of Neurosciences in Rural Practice Journal of Neurosciences in Rural Practice, Vol 04, Iss 02, Pp 176-179 (2013) Journal of Neurosciences in Rural Practice, Vol 4, Iss 2, Pp 176-179 (2013) |
| ISSN: | 0976-3155 0976-3147 |
| Popis: | Herpes simplex encephalitis (HSE) still remains a serious illness with high morbidity and mortality. The characteristic presentation of HSE usually consists of fever, headache, and altered mental function. We present three patients with atypical features of HSE. First, a 48‑year‑old man with symptomatic posttraumatic epilepsy, who developed a gastrointestinal infection, seizures, and fever. After significant clinical improvement, the patient had fever again and developed a status epilepticus, which led to the diagnosis of HSE. Second, an 84‑year‑old woman with hyperactive delirium after levofloxacin intake. Cranial computed tomography (CCT) revealed hypodense temporal changes, prompting lumbar puncture and diagnosis of HSE. Third, a 51‑year‑old diabetic woman presented with fever and acute confusion. As CCT and cell count of cerebrospinal fluid (CSF) were normal, infection and hyperglycemia as initial diagnoses were postulated. Due to aphasic symptoms, the differential diagnosis of a stroke was taken into account. Thus a second lumbar puncture led to the correct diagnosis of HSE. These atypical presentations need a high grade of suspicion and a high willingness to reconsider the initial working diagnosis, in order to prevent a diagnostic delay. |
| Databáze: | OpenAIRE |
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