Author/Editor		Jereb, Matjaž; Popovič, Mara; Muzlovič, Igor; Lainščak, Mitja
Title		Herpes simpleks meningoencefalitis neznačilne lokalizacije
Translated title		Herpes simplex meningoencephalitis of atypical localization
Type		članek
Source		In: Bručan A, Gričar M, Vajd R, editors. Urgentna medicina: izbrana poglavja 8. Zbornik 9. mednarodni simpozij o urgentni medicini; 2002 jun 19-22; Portorož. Ljubljana: Slovensko združenje za urgentno medicino,
Publication year		2002
Volume		str. 173-7
Language		slo
Abstract		Introduction. Focal meningoencephalitis is commonly caused by Herpes simplex virus reactivation or reinfection, which typically affects temporal and frontal lobes with rare involvement of other localisations. Patients present with fever, impaired consciousness, behavioural changes, headache, focal or generalized seizures and signs of cranial nerves involvement. Etiological diagnosis is based upon microbiologic tests with polymerase chain reaction in cerebrospinal fluid and virus demonstration in tissue obtained at brain biopsy. Typical electroencephalogram shows spike and slow-wave activity and periodic lateralized epileptiform discharges, which arise from affected lobe. Magnetic resonance imaging is, especially early in the course of the infection, more specific and sensitive than computer tomography. Mortality exceeds 70% in untreated patients but can be significantly lowered with acyclovir, which can not exclude persistent neurological deficit. A 46 years old male was admitted to the hospital with three day history of headache, fever, temperature up to 39 degrees C and treatment with amoxicilin and paracetamole. Initial studies gave following results: lumbar puncture was in favour of serous meningitis and basic laboratory tests pointed to viral infection. On the fifth day patient presented with double vision followed by confusion, walking difficulties and inability to look to the right. Convergent strabism and vertical nystagmus were detected. Further impairment of consciousness finally led to coma. Repeated lumbar puncture showed low sugar concentration. Bacterial infection was suspected and we started treatment with cefotaxim and ampicilin. Serology to arbo B virus, Borrelia burgdorferi and Mycoplasma pneumoniae were negative but we detected elevated serum titres to specific IgG antibodies to Herpes simplex virus type 1 and Chlamydia pneumoniae. (Abstract truncated at 2000 characters).
Descriptors		ENCEPHALITIS, VIRAL HERPES SIMPLEX MIDDLE AGE