4 Cases of Aseptic Encephalitis Mimicking Right Middle Cerebral Artery Syndrome (P6.028)

We present 4 cases of presumed aseptic encephalitis in Southern California all causing a transient right MCA syndrome (eyes deviated to the right, left hemianopia, left hemiparesis, and inattention), with 3 of them presenting within a 10 day period, and all within a geographic radius of 40 miles. None of these cases had right MCA vascular occlusions, ischemic infarcts on imaging or severe hyperglycemia. All patients had near-complete resolution of the right MCA syndromes between 3-12 days. 2 of 4 cases developed complex or secondary generalized partial motor seizures requiring treatment with antiepileptic drugs. Every patient was severely hypertensive, often> 200 systolic however brain MRI did not show subcortical white matter edema suggestive of PRES. 3 of the 4 cases exhibited CSF pleocytosis ranging from 20-70 WBC’s with all having mildly elevated protein and normal glucose. Of the 3 patients with abnormal cell count, all were neutrophil predominant. Viral serology including HSV, WNV, VZV, mycoplasma and enterovirus were negative in all 4 patients. 2 of 4 cases had recurrent symptoms of unclear etiology. An EEG was performed in 3 of 4 cases, none revealing epileptiform activity. 2 of the 3 EEG’s showed right or left hemisphere slowing. Cases 2-4 all presented within a 10-day period from the greater Los Angeles area. Given the temporal and geographic proximity of these cases with 2 of 4 cases demonstrating fevers and 3 of 4 with CSF pleocytosis and all having...
Source: Neurology - Category: Neurology Authors: Tags: Ischemic Stroke Diagnosis Source Type: research

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