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IPLab:Lab 8:HSV Encephalitis

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== 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 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 ==
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).
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== Virtual Microscopy ==
<peir-vm>IPLab8HSVEncephalitis</peir-vm>
== Study Questions ==
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/218580-overview eMedicine Medical Library: Herpes Simplex]* [http://emedicine.medscape.com/article/783113-overview eMedicine Medical Library: Herpes Simplex in Emergency Medicine]* [http://emedicine.medscape.com/article/1165183-overview eMedicine Medical Library: Herpes Simplex Encephalitis]* [http://www.merckmanuals.com/professional/infectious_diseases/herpesviruses/herpes_simplex_virus_hsv_infections.html Merck Manual: Herpes Simplex Virus (HSV) Infections]* [http://www.merckmanuals.com/professional/neurologic_disorders/brain_infections/encephalitis.html Merck Manual: Encephalitis]
=== Journal Articles ===
* 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.* 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 ===
* [{{SERVER}}/library/index.php?/tags/127-herpes PEIR Digital Library: Herpes Images]* [http://library.med.utah.edu/WebPath/CNSHTML/CNSIDX.html#6 WebPath: CNS Infections]
== Related IPLab Cases ==
* [[IPLab:Lab 8:HSV Glossitis|Lab 8: Herpes Glossitis]]
{{IPLab 8}}
[[Category: IPLab:Lab 8]]
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