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 encephalitis11. Tien RD, Felsberg GJ, Osumi AK. Herpes virus infections of the CNS: MR findings. AJR Am J Roentgenol 1993;161:167-176. or autoimmune paraneoplastic limbic encephalitis22. 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.. However, neurosyphilis must also be considered.
References
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1Tien RD, Felsberg GJ, Osumi AK. Herpes virus infections of the CNS: MR findings. AJR Am J Roentgenol 1993;161:167-176.
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2Gultekin 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
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Publication in this collection
Apr 2013
History
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Received
24 Sept 2012 -
Received
3 Dec 2012 -
Accepted
11 Dec 2012