165 A creepy diagnosis

A 44-year-old-female presented with 3 weeks history of sacral anaesthesia, painful left leg paraesthesia and urinary retention requiring intermittent self-catheterisation. A week prior, she had headache, flu-like symptoms and dysuria and received oral antibiotics for E-Coli urinary infection with a negative vaginal swab. She was systemically well. On examination, there was mild left ankle dorsiflexion and plantar flexion weakness, brisk lower limb reflexes and altered sensation in left L5 and bilateral S1 dermatomes. MRI of her whole spine showed subtle signal change in the conus medullaris. CSF revealed 113 white blood cells (80% lymphocytes) with normal protein and glucose and negative oligoclonal bands. Her CT chest,abdomen and pelvis was unremarkable as were: autoimmune and vasculitis screening, serum ACE, vitamin B12, LDH, copper, HIV, syphilis, Lyme, HTLV1&6, Hepatitis B&C, MOG and Aquaporin 4 antibodies. CSF Herpes simplex virus 2 (HSV2) polymerase chain reaction was positive, confirming a diagnosis of HSV2 myeloradiculitis (Elsberg’s syndrome). She was treated with intravenous acyclovir for three weeks with significant clinical response and she was discharged on long-term daily oral acyclovir. Elsberg syndrome is presumed infective (HSV2) acute or subacute bilateral lumbosacral radiculomy- elitis and should be considered in patients with CSF pleocytosis, urologic dysfunction and lumbosacral radiculomyeliitis. maryam.talaei@wales.nhs.uk
Source: Journal of Neurology, Neurosurgery and Psychiatry - Category: Neurosurgery Authors: Tags: Poster Presentations Source Type: research