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Acute disseminated encephalomyelitis following aseptic meningoencephalitis
S Shintani1, Y Fumimura, T Shiigai
1Department of Neurology, Toride Kyodo General Hospital, 2-1-1 Hongoh, Toride City, 302-0022, Ibaraki, Japan. dw4s-sntn@asahi-net.or.jp
Abstract:
A previously healthy 50-year-old man developed aseptic meningoencephalitis with clinical manifestations including fever, headache, seizure, Wernicke aphasia, right hemiplegia, and blindness in the left eye. One and one-half months after remission of meningoencephalitis, marked ataxia and psychiatric symptoms became apparent. Magnetic resonance imaging revealed multiple new lesions involving the basal ganglia, thalamus, white matter, and cerebellum. Despite these developments, cerebrospinal fluid findings continued to improve except for excessive content of myelin basic protein. Within 2 weeks, steroid therapy dramatically resolved the ataxic symptoms and disseminated lesions.
Insights
A previously healthy man experienced aseptic meningoencephalitis, followed by ataxia and psychiatric symptoms. Steroid therapy rapidly resolved these neurological issues and brain lesions.
Area of Science:
- Neurology
- Neuroimmunology
- Infectious Diseases
Background:
- Aseptic meningoencephalitis is an inflammatory condition affecting the brain and meninges.
- Early diagnosis and treatment are crucial for managing neurological disorders.
Observation:
- A 50-year-old man presented with acute aseptic meningoencephalitis, exhibiting fever, headache, seizure, Wernicke aphasia, hemiplegia, and blindness.
- Post-remission, he developed significant ataxia and psychiatric symptoms.
- MRI revealed new lesions in the basal ganglia, thalamus, white matter, and cerebellum.
- Cerebrospinal fluid showed elevated myelin basic protein despite overall improvement.
Findings:
- Steroid therapy led to a rapid and dramatic resolution of ataxic symptoms and disseminated brain lesions.
- Elevated myelin basic protein in cerebrospinal fluid may indicate ongoing demyelination or inflammation.
Implications:
- This case highlights the potential for delayed neurological complications following aseptic meningoencephalitis.
- Early and aggressive treatment with corticosteroids can be effective in managing severe neurological sequelae.
- Myelin basic protein levels may serve as a biomarker for treatment response in such conditions.