Difference between revisions of "IPLab:Lab 8:HSV Encephalitis"

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== Clinical Summary ==
 
== Clinical Summary ==
  
This 30-year-old white male experienced a generalized tonic-clonic seizure and was subsequently started on a course of Dilantin. He did well, but later developed a headache lasting over a week, which was associated with tonic-clonic seizures, fever, and--toward the end of this period--ataxia. The patient improved and returned to work, but the headache returned. A lumbar puncture was then performed which showed 22 cells/cmm (all lymphocytes), protein of 88 grams/L, and a glucose level of 49 mg/dL (with a simultaneous serum glucose of 83 mg/dL). These findings were compatible with a viral infection. Despite therapy, the patient had another seizure and again developed fever. At that time, a brain biopsy was performed which showed herpetic encephalitis. Despite aggressive antiviral therapy the patient died.  
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This 30-year-old white male experienced a generalized tonic-clonic seizure and was subsequently started on a course of Dilantin. He did well, but later developed a headache lasting over a week, which was associated with tonic-clonic seizures, fever, and--toward the end of this period--ataxia. The patient improved and returned to work, but the headache returned. A lumbar puncture was then performed which showed 22 cells/mm³ (all lymphocytes), protein of 88 grams/L, and a glucose level of 49 mg/dL (with a simultaneous serum glucose of 83 mg/dL). These findings were compatible with a viral infection. Despite therapy, the patient had another seizure and again developed fever. At that time, a brain biopsy was performed which showed herpetic encephalitis. Despite aggressive antiviral therapy the patient died.
  
 
== Images ==
 
== Images ==
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IPLab8HSVEncephalitis12.jpg|This is a photomicrograph of a brain section stained with an antibody against herpes simplex. Even at this magnification, it is easy to pick out cells that are positive for the virus (arrows).  
 
IPLab8HSVEncephalitis12.jpg|This is a photomicrograph of a brain section stained with an antibody against herpes simplex. Even at this magnification, it is easy to pick out cells that are positive for the virus (arrows).  
 
</gallery>
 
</gallery>
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== Virtual Microscopy ==
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<peir-vm>IPLab8HSVEncephalitis</peir-vm>
  
 
== Study Questions ==
 
== Study Questions ==
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== Additional Resources ==
 
== Additional Resources ==
 
=== Reference ===
 
=== Reference ===
 
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* [http://emedicine.medscape.com/article/218580-overview eMedicine Medical Library: Herpes Simplex]
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* [http://emedicine.medscape.com/article/783113-overview eMedicine Medical Library: Herpes Simplex in Emergency Medicine]
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* [http://emedicine.medscape.com/article/1165183-overview eMedicine Medical Library: Herpes Simplex Encephalitis]
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* [http://www.merckmanuals.com/professional/infectious_diseases/herpesviruses/herpes_simplex_virus_hsv_infections.html Merck Manual: Herpes Simplex Virus (HSV) Infections]
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* [http://www.merckmanuals.com/professional/neurologic_disorders/brain_infections/encephalitis.html Merck Manual: Encephalitis]
  
 
=== Journal Articles ===
 
=== Journal Articles ===
 
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* Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW; American College of Emergency Physicians.  [http://www.ncbi.nlm.nih.gov/pubmed/18809105 Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache].  ''Ann Emerg Med'' 2008 Oct;52(4):407-36.
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* Thomson RB Jr, Bertram H.  [http://www.ncbi.nlm.nih.gov/pubmed/11780267 Laboratory diagnosis of central nervous system infections].  ''Infect Dis Clin North Am'' 2001 Dec;15(4):1047-71.
  
 
=== Images ===
 
=== Images ===
 
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* [{{SERVER}}/library/index.php?/tags/127-herpes PEIR Digital Library: Herpes Images]
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* [http://library.med.utah.edu/WebPath/CNSHTML/CNSIDX.html#6 WebPath: CNS Infections]
  
 
== Related IPLab Cases ==
 
== Related IPLab Cases ==
 
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* [[IPLab:Lab 8:HSV Glossitis|Lab 8: Herpes Glossitis]]
  
 
{{IPLab 8}}
 
{{IPLab 8}}
  
 
[[Category: IPLab:Lab 8]]
 
[[Category: IPLab:Lab 8]]

Latest revision as of 16:28, 3 January 2014

Clinical Summary[edit]

This 30-year-old white male experienced a generalized tonic-clonic seizure and was subsequently started on a course of Dilantin. He did well, but later developed a headache lasting over a week, which was associated with tonic-clonic seizures, fever, and--toward the end of this period--ataxia. The patient improved and returned to work, but the headache returned. A lumbar puncture was then performed which showed 22 cells/mm³ (all lymphocytes), protein of 88 grams/L, and a glucose level of 49 mg/dL (with a simultaneous serum glucose of 83 mg/dL). These findings were compatible with a viral infection. Despite therapy, the patient had another seizure and again developed fever. At that time, a brain biopsy was performed which showed herpetic encephalitis. Despite aggressive antiviral therapy the patient died.

Images[edit]

Virtual Microscopy[edit]

Study Questions[edit]


Additional Resources[edit]

Reference[edit]

Journal Articles[edit]

Images[edit]

Related IPLab Cases[edit]

A tonic-clonic seizure involves loss of consciousness followed by tonic, then clonic, convulsions.

A tonic-clonic seizure involves loss of consciousness followed by tonic, then clonic, convulsions.

A normal number of cells in CSF is <4 lymphocytes per mm³.

A normal protein level for CSF should be < 0.4 grams/L.

A normal CSF glucose level should be approximately 70% of the patient's serum glucose level.

An infiltrate is an accumulation of cells in the lung parenchyma--this is a sign of pneumonia.