A case of immunotherapy-responsive eastern equine encephalitis with diffusion-weighted imaging
2001; Lippincott Williams & Wilkins; Volume: 56; Issue: 3 Linguagem: Inglês
10.1212/wnl.56.3.420
ISSN1526-632X
AutoresMeredith R. Golomb, M. Durand, Pamela W. Schaefer, Colin T. McDonald, Matheus L. Maia, Lee H. Schwamm,
Tópico(s)Viral Infections and Vectors
ResumoEastern equine encephalitis (EEE) is the most severe of the mosquito-borne encephalitides, associated with 30% mortality. Age over 40, rapid progression to coma, severe hyponatremia, and CSF white blood cell count >500 at symptom onset have all been correlated with poor outcome.1,2⇓ We report a patient with poor prognostic signs in whom apparent diffusion coefficient (ADC) images revealed vasogenic edema without ischemia. He made a complete recovery after treatment with steroids and IV immunoglobulin (IVIg). A 69-year-old man from southeastern Massachusetts developed a frontal headache, fever, and mild right upper extremity weakness precipitating admission to a local hospital. The following day, he developed fever to 104 °F, rapidly progressive flaccid paraparesis, and acute respiratory failure. A CT brain scan without contrast was normal. A lumbar puncture revealed 1196 white blood cells (WBC) (80% neutrophils, 2% lymphocytes), 12 red blood cells/cubic millimeter, total protein 140 mg/dL, and glucose 74 mg/dL (serum glucose of 121 mg/dL) without organisms on Gram stain or detection of cryptococcal antigen. Serum chemistries were normal except …
Referência(s)