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Herpes Encephalitis (HSV 1)

USU Teaching File MUTF - MedPix

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Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Herpes Encephalitis (HSV 1)

History: 34 yo man from Guantanamo Bay presents with confusion. On day of presentation, he was discovered by roommates to be confused and drooling, oriented only to person. Following treatment at ED in Cuba, he was evacuated stateside for further care.

Findings: MRI revealed increased T2 signal intensity in R frontotemporal region, as well as insular gyri, right worse than left. R cingulate gyrus noted to have increased signal intensity compared to L side. Mild effacement of right lateral ventricle is also seen.

Ddx: A. Vascular – 1. ischemia 2. infarction B. Inflammatory – 1. encephalitis 2. meningitis 3. meningoencephalitis

Dxhow: HSV-1 CSF Viral Titers

Exam: Rectal temp at time of ED presentation was 102.8. LP performed at ED in Cuba revealed CSF white count of 98, RBC 600, Protein 40, Gram Stain significant for Gram Positive Cocci. PE stateside revealed an obtunded WNWD male, responsive only to noxious stimuli, with asymmetric pupils, L larger than R. HSV 1 CSF titer HIGH, HSV II negative.

No MeSH data available.


MRI revealed increased T2 signal intensity in R frontotemporal region, as well as insular gyri, right worse than left. Both cingulate gyri have increased signal intensity.  Mild effacement of right lateral ventricle.
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MPX1838_synpic19188: MRI revealed increased T2 signal intensity in R frontotemporal region, as well as insular gyri, right worse than left. Both cingulate gyri have increased signal intensity. Mild effacement of right lateral ventricle.


Herpes Encephalitis (HSV 1)

USU Teaching File MUTF - MedPix

MRI revealed increased T2 signal intensity in R frontotemporal region, as well as insular gyri, right worse than left. Both cingulate gyri have increased signal intensity.  Mild effacement of right lateral ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1838&req=5

MPX1838_synpic19188: MRI revealed increased T2 signal intensity in R frontotemporal region, as well as insular gyri, right worse than left. Both cingulate gyri have increased signal intensity. Mild effacement of right lateral ventricle.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Herpes Encephalitis (HSV 1)

History: 34 yo man from Guantanamo Bay presents with confusion. On day of presentation, he was discovered by roommates to be confused and drooling, oriented only to person. Following treatment at ED in Cuba, he was evacuated stateside for further care.

Findings: MRI revealed increased T2 signal intensity in R frontotemporal region, as well as insular gyri, right worse than left. R cingulate gyrus noted to have increased signal intensity compared to L side. Mild effacement of right lateral ventricle is also seen.

Ddx: A. Vascular – 1. ischemia 2. infarction B. Inflammatory – 1. encephalitis 2. meningitis 3. meningoencephalitis

Dxhow: HSV-1 CSF Viral Titers

Exam: Rectal temp at time of ED presentation was 102.8. LP performed at ED in Cuba revealed CSF white count of 98, RBC 600, Protein 40, Gram Stain significant for Gram Positive Cocci. PE stateside revealed an obtunded WNWD male, responsive only to noxious stimuli, with asymmetric pupils, L larger than R. HSV 1 CSF titer HIGH, HSV II negative.

No MeSH data available.