A Case of Encephalitis

by

Miguel Andrés Ibañez, M.D.

Antecedents:

bulletDepression from 1992. 
bulletChronic migraines
bulletModerate arterial hypertension
bulletHypothyroidism
bulletObesity (BMI 37.1)

Previous Surgery: 

bulletDiscectomy in November 1998 
bullet Hysterectomy, March 1999 
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Cholecystectomy, July 2000 

Medication: 

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Fluox 20 mg

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T4 100 ug

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Diazepam 10 mg 

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Clonazepam 2 mg

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Carbamazepine 200 mg 

History:

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May 20, 2001:  She was in her usual good state of health.  She went to sleep that evening. 

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May 21, 2001:  She didn't wake up.  She had her first CT scan. 

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May 22, 2001:  She arrives at my hospital.  At that time she was unresponsive to painful stimulation.  Her respiratory rate and pattern were normal.  Pupils were in midposition, equal and reactive.  Blood gas: pH: 7.46,  pCO2: 34.3,  pO2: 48.3,  84% sat.  Electrolytes: Bicarbonate 24,  Sodium 142,  BD.0.1,  Potassium: 3.5,  Calcium 6.7, Magnesium 1.6,  Glucose 111.  Hct: 36%,  Hb.12.4 gm,  WBC: 17600.  No stiff neck.  Temp 38 centigrade degrees but she has a urinary tract infection. Traumatic tap. RBC: 280,  WBC: 0,  Protein 26 and Glucose: 76.  (negative cultures).  First MRI.

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May 24, 2001:   Second CAT scan. 

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May 28, 2001:   Second MRI.  The images are eloquent for themselves. 

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Current exam: At the moment: Mutism, extrapyramidal syndrome, hemiparesis and involuntary movements (myoclonus, dystonia).  No oculogyric crises. 

Thank you all for your advice and insights.

CT Scan (May 21, 2001)

MRI Scan (May 22, 2001)

CT Scan (May 24, 2001)

MRI Scan (May 28, 2001)

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Revised June 23, 2001

(c) 2001 Medical College of Georgia