Mrad Luay, Moustakas Argirios, Fuino Robert, Waheed Waqar
Department of Neurological Sciences, University of Vermont Medical Center, Burlington, Vermont, USA.
BMJ Case Rep. 2019 Jul 22;12(7):e230005. doi: 10.1136/bcr-2019-230005.
A 75-year-old woman presented with new onset of confusion, intense episodic dizziness and formed visual hallucinations. Herpes simplex encephalitis and non-convulsive temporal lobe seizures were confirmed with cerebrospinal fluid (CSF) and electroencephalography testing. In addition, her hospital course was complicated by syndrome of inappropriate antidiuretic hormone secretion and atonic bladder contributing to an episode of urinary tract infection. After completing 3 weeks of acyclovir treatment, the patient became obtunded with right arm choreiform movements and persistent inflammatory CSF findings not attributable to persistent herpes simplex virus infection or other confounding factors. The patient responded to steroid treatment. Repeated autoimmune and paraneoplastic evaluations were negative. Both clinical (cognitive testing and atonic bladder) and CSF inflammatory finding improved in the follow-up period.
一名75岁女性出现新发的意识模糊、剧烈发作性头晕和成形视幻觉。通过脑脊液（CSF）和脑电图检查确诊为单纯疱疹病毒性脑炎和非惊厥性颞叶癫痫。此外，她的住院过程因抗利尿激素分泌不当综合征和无张力膀胱导致尿路感染发作而变得复杂。在完成3周的阿昔洛韦治疗后，患者变得意识不清，出现右臂舞蹈样动作，脑脊液持续存在炎症表现，这并非由持续性单纯疱疹病毒感染或其他混杂因素所致。患者对类固醇治疗有反应。重复进行的自身免疫和副肿瘤评估均为阴性。在随访期间，临床症状（认知测试和无张力膀胱）和脑脊液炎症表现均有所改善。
