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A case of enteroviral meningoencephalitis presenting as rapidly progressive dementia

Nature Clinical Practice Neurology volume 4, pages 399–403 (2008)Cite this article

Abstract

Background A 70-year-old immunocompetent male presented to a memory disorders clinic with a 7-month illness that had begun with somatic complaints including transient right temporal head pain, left buttock pain, and right conjunctival injection. About 3 months after the first signs of illness, the patient had begun to develop insidious cognitive and behavioral decline, which progressed most rapidly in the 2 months before presentation. An assessment completed during hospitalization for intermittent fevers and confusion had not revealed an infectious etiology, although mild pleocytosis in the cerebrospinal fluid had been noted. Upon presentation to the memory disorders clinic, the patient was disoriented, distractible, laughed at inappropriate moments, and followed only one-step commands. He had hypophonic speech and had mildly increased axial tone. He scored 5 out of 30 on the Mini Mental State Examination and was admitted for expedited evaluation.

Investigations Physical examination, brain MRI, electroencephalogram, lumbar puncture, autoimmune and paraneoplastic testing, cerebral angiogram, cerebrospinal fluid analysis, enterovirus group-specific reverse transcriptase polymerase chain reaction assay, and RNA sequencing in brain biopsy samples.

Diagnosis Enteroviral meningoencephalitis.

Management Intravenous steroids with oral taper and intravenous immunoglobulin.

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Figure 1: MRI scans of the patient's brain before surgery.
Figure 2: A brain biopsy specimen stained with hemotoxylin and eosin showed foci of microglia and lymphocytes involving the leptomeninges and neuropil.

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Authors and Affiliations

  1. Department of Neurology, AT Parsa is an Associate Professor of Neurological Surgery in the Department of Neurosurgery, and T Tihan is an Associate Professor of Pathology in the Department of Pathology, V Valcour is a Fellow in Neurobehavior, A Haman is a Research Analyst, S Cornes is a Clinical Instructor of Neurology, C Lawall is a Resident in Neurology, and M Geschwind is an Assistant Professor of Neurology, in the Memory and Aging Center, all at the University of California, San Francisco, CA.,

    Victor Valcour, Aissa Haman, Susannah Cornes, Carson Lawall, Andrew T Parsa, Tarik Tihan & Michael Geschwind

  2. in the Division of Communicable Disease Control, California Department of Public Health, C Glaser is Principal Investigator for the California Encephalitis Project and Chief of the Viral and Rickettsial Disease Laboratory, and S Yagi is a Research Scientist in the Viral and Rickettsial Disease Laboratory, Richmond, CA.,

    Carol Glaser & Shigeo Yagi

  3. J Bhatnagar is a Microbiologist in the Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.,

    Julu Bhatnagar

Authors
  1. Victor Valcour
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  2. Aissa Haman
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  3. Susannah Cornes
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  4. Carson Lawall
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  5. Andrew T Parsa
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  6. Carol Glaser
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  7. Shigeo Yagi
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  8. Tarik Tihan
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  9. Julu Bhatnagar
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  10. Michael Geschwind
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Corresponding author

Correspondence to Victor Valcour.

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The authors declare no competing financial interests.

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Valcour, V., Haman, A., Cornes, S. et al. A case of enteroviral meningoencephalitis presenting as rapidly progressive dementia. Nat Rev Neurol 4, 399–403 (2008). https://doi.org/10.1038/ncpneuro0804

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