A male patient with delirium, seizures and (limbic) encephalitis with bilateral mesial temporal lobe involvement

Um paciente do gênero masculino com delirium e crises convulsivas por encefalite límbica, com comprometimento bilateral dos lobos temporais mesiais

A 52-year-old male presented with a fortnight history of delirium and partial motor seizures. He had no fever or other systemic or neurological signs, but he showed a mini-mental state examination (MMSE) score of 8/30. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance images (MRI) of the head revealed hyperintense signals in both temporal lobes (Figure). Serologies for herpes simplex virus, varicella zoster virus, toxoplasma, cytomegalovirus, Epstein-barr virus, and HIV were negative, but fluorescent treponemal antibody-absorption (FTA-Abs) and venereal disease research laboratory (VDRL) (1:32) were reactive. Cerebrospinal fluid (CSF) examination revealed 10 leukocytes/mm³ (95% lympho cytes), 77 mg/dL protein, 75 mg/dL glucose, and VDRL 1:2. Mesial temporal lesions are commonly associated with herpetic encephalitis¹ or autoimmune paraneoplastic limbic encephalitis². However, neurosyphilis must also be considered.

Figure.
Fluid-attenuated inversion recovery (FLAIR) axial (A) and coronal (B) magnetic resonance images showing bilateral medial temporal high-signal lesions with associated asymmetric enlargement of the temporal horns of the lateral ventricles. The enlargement is more marked on the right side.

References

• ¹
  Tien RD, Felsberg GJ, Osumi AK. Herpes virus infections of the CNS: MR findings. AJR Am J Roentgenol 1993;161:167-176.
• ²
  Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain 2000;123:1481-1494.

Publication Dates

• Publication in this collection
  Apr 2013

History

• Received
  24 Sept 2012
• Received
  3 Dec 2012
• Accepted
  11 Dec 2012