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Non-herpetic fulminant meningoencephalitis with periodic lateralised epileptiform discharges
Akinori Nakamura1, Takao Hashimoto, Masayuki Matsuda
1Third Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. anakamu@hsp.md.shinshu-u.ac.jp
Abstract:
This report concerns two patients with fulminant meningoencephalitis presenting in status epilepticus with periodic lateralised epileptiform discharges (PLEDs) observed on electroencephalogram. The titer of herpes simplex virus type 1 antibody was not elevated in either serum or cerebrospinal fluid, and acyclovir was not effective for either patient. Corticosteroid therapy was dramatically effective, however, suggesting that autoimmune inflammatory diseases were the underlying systemic disorders. PLEDs can thus be associated with steroid-responsive inflammatory meningoencephalitis.
Insights
Fulminant meningoencephalitis with periodic lateralized epileptiform discharges (PLEDs) can be a steroid-responsive autoimmune condition, not solely caused by herpes simplex virus. This finding suggests a new treatment approach for severe brain inflammation.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Fulminant meningoencephalitis is a severe brain inflammation.
- Status epilepticus with periodic lateralized epileptiform discharges (PLEDs) on electroencephalogram indicates serious neurological dysfunction.
- Herpes simplex virus (HSV) is a common cause of encephalitis, often treated with acyclovir.
Observation:
- Two patients presented with fulminant meningoencephalitis and status epilepticus with PLEDs.
- Neither patient showed elevated herpes simplex virus type 1 antibody titers in serum or cerebrospinal fluid.
- Acyclovir treatment was ineffective for both patients.
Findings:
- Corticosteroid therapy demonstrated a dramatic positive effect in both patients.
- The effectiveness of corticosteroids suggests an underlying autoimmune inflammatory process.
- Periodic lateralized epileptiform discharges (PLEDs) were associated with steroid-responsive inflammatory meningoencephalitis.
Implications:
- This case report broadens the differential diagnosis for meningoencephalitis presenting with PLEDs.
- It highlights the potential role of autoimmune mechanisms in certain cases of severe encephalitis.
- It suggests that prompt corticosteroid administration may be a crucial therapeutic option for steroid-responsive inflammatory meningoencephalitis.