Answer
Choice “D” is the best answer choice. This patient has findings on axial diffusion-weighted MRI, which show high signal activity in the cortex of the temporal lobes and insula, much more marked on the right. This finding is consistent with a diagnosis of herpes simplex encephalitis (HSVE). An MRI of the brain is the preferred imaging study in patients with suspected HSVE. Proton-density and T2 images may be more helpful than T1 images. An MRI can noninvasively establish many of the potential alternative diagnoses of HSVE. Abnormalities are found in 90% of patients with HSVE; an MRI may be normal early in the course of illness[1]. Temporal lobe involvement, sometimes hemorrhagic, and early involvement of white matter are typical. The …show more content…
Coxsackieviruses and echoviruses, which are enteroviruses, account for approximately half of cases of aseptic meningitis. The epidemiologic setting (e.g., time of year, geographic locale, exposure to insects, diseases prevalent in the local community) and accompanying systemic manifestations are helpful in making a presumptive diagnosis. The clinical and laboratory findings accompanying acute viral meningitis are usually insufficiently distinct to allow an etiologic diagnosis, and distinguishing these disorders from a number of nonviral diseases may be difficult. Treatment varies with the cause. No specific pharmacologic treatment is available for most cases of viral meningitis; these patients are managed with supportive therapy, which includes analgesics, antiemetics, intravenous fluids, and prevention and treatment of …show more content…
This patient has no previous history of tick bite, rash (erythema migrans lesions), or cranial neuropathies to suggest Lyme neuroborreliosis. Lyme neuroborreliosis is reported in 5%–20% of cases of patients of untreated Lyme disease. Cranial neuropathy is the most common manifestation of early neurologic Lyme disease, especially facial nerve palsy (Bell palsy), seen in approximately 3% of patients. In endemic areas, Lyme disease is the most commonly identified cause of acquired facial palsy, especially in children. Headache, absence of previous herpetic lesions, and meningeal symptoms are noted in most pediatric Lyme disease patients with facial palsy. With meningitis, symptoms of headache, neck pain or stiffness, and photophobia are seen 2–10 weeks after infection. Borrelia encephalopathy most commonly manifests as a mild confusional state accompanied by disturbances in memory, concentration, mood, sleep, personality, and/or language occurring months to years after the infection. Depression and irritability are also
Choice “D” is the best answer choice. This patient has findings on axial diffusion-weighted MRI, which show high signal activity in the cortex of the temporal lobes and insula, much more marked on the right. This finding is consistent with a diagnosis of herpes simplex encephalitis (HSVE). An MRI of the brain is the preferred imaging study in patients with suspected HSVE. Proton-density and T2 images may be more helpful than T1 images. An MRI can noninvasively establish many of the potential alternative diagnoses of HSVE. Abnormalities are found in 90% of patients with HSVE; an MRI may be normal early in the course of illness[1]. Temporal lobe involvement, sometimes hemorrhagic, and early involvement of white matter are typical. The …show more content…
Coxsackieviruses and echoviruses, which are enteroviruses, account for approximately half of cases of aseptic meningitis. The epidemiologic setting (e.g., time of year, geographic locale, exposure to insects, diseases prevalent in the local community) and accompanying systemic manifestations are helpful in making a presumptive diagnosis. The clinical and laboratory findings accompanying acute viral meningitis are usually insufficiently distinct to allow an etiologic diagnosis, and distinguishing these disorders from a number of nonviral diseases may be difficult. Treatment varies with the cause. No specific pharmacologic treatment is available for most cases of viral meningitis; these patients are managed with supportive therapy, which includes analgesics, antiemetics, intravenous fluids, and prevention and treatment of …show more content…
This patient has no previous history of tick bite, rash (erythema migrans lesions), or cranial neuropathies to suggest Lyme neuroborreliosis. Lyme neuroborreliosis is reported in 5%–20% of cases of patients of untreated Lyme disease. Cranial neuropathy is the most common manifestation of early neurologic Lyme disease, especially facial nerve palsy (Bell palsy), seen in approximately 3% of patients. In endemic areas, Lyme disease is the most commonly identified cause of acquired facial palsy, especially in children. Headache, absence of previous herpetic lesions, and meningeal symptoms are noted in most pediatric Lyme disease patients with facial palsy. With meningitis, symptoms of headache, neck pain or stiffness, and photophobia are seen 2–10 weeks after infection. Borrelia encephalopathy most commonly manifests as a mild confusional state accompanied by disturbances in memory, concentration, mood, sleep, personality, and/or language occurring months to years after the infection. Depression and irritability are also