Abdelmalik Peter A, Ambrose Timothy, Bell Rodney
Department of Anesthesia and Critical Care Medicine, Neurosciences Division, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Department of Neurology, Thomas Jefferson University Hospitals, Philadelphia, PA 19107, USA.
Case Rep Neurol Med. 2015;2015:673724. doi: 10.1155/2015/673724. Epub 2015 Dec 3.
Objective. Stroke is a clinical diagnosis, with a history and physical examination significant for acute onset focal neurological symptoms and signs, often occurring in patients with known vascular risk factors and is frequently confirmed radiographically. Case Report. A 79-year-old right-handed woman, with a past medical history of hypertension, hyperlipidemia, and prior transient ischemic attack (TIA), presented with acute onset global aphasia and right hemiparesis, in the absence of fever or prodrome. This was initially diagnosed as a proximal left middle cerebral artery (MCA) stroke. However, CT perfusion failed to show evidence of reduced blood volume, and CT angiogram did not show evidence of a proximal vessel occlusion. Furthermore, MRI brain did not demonstrate any areas of restricted diffusion. EEG demonstrated left temporal periodic lateralized epileptiform discharges (PLEDs). The patient was empirically loaded with a bolus valproic acid and started on acyclovir, both intravenously. CSF examination demonstrated a pleocytosis and PCR confirmed the diagnosis of herpes simplex viral encephalitis (HSVE). Conclusions. HSVE classically presents in a nonspecific fashion with fever, headache, and altered mental status. However, acute focal neurological signs, mimicking stroke, are possible. A high degree of suspicion is required to institute appropriate therapy and decrease morbidity and mortality associated with HSVE.
目的。中风是一种临床诊断，根据病史和体格检查，其特征为急性发作的局灶性神经症状和体征，常见于有已知血管危险因素的患者，且常通过影像学检查得以确诊。病例报告。一名79岁右利手女性，有高血压、高脂血症病史及既往短暂性脑缺血发作（TIA）史，出现急性起病的完全性失语和右侧偏瘫，无发热或前驱症状。最初诊断为左侧大脑中动脉（MCA）近端卒中。然而，CT灌注检查未显示血容量减少的证据，CT血管造影也未显示近端血管闭塞的证据。此外，脑部MRI未显示任何扩散受限区域。脑电图显示左侧颞叶周期性局灶性癫痫样放电（PLEDs）。该患者经验性静脉注射大剂量丙戊酸并开始使用阿昔洛韦。脑脊液检查显示细胞增多，PCR确诊为单纯疱疹病毒性脑炎（HSVE）。结论。HSVE通常以非特异性方式表现为发热、头痛和精神状态改变。然而，也可能出现类似中风的急性局灶性神经体征。需要高度怀疑才能采取适当治疗，降低与HSVE相关的发病率和死亡率。
