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Case No. 316
2013-09-02~2013-09-30
출제자 : 차지훈
Hit : 442
| Period | 2013-09-02~2013-09-30 |
|---|---|
| Diagnosis | herpes encephalitis |
| Clinical information | F/39 CC: fever, headache, seizure, 진단은? |
| Discussion | 답: herpes encephalitis 해설 Herpes encephalitis is acute hemorrhagic, necrotizing encephalitis caused by herpes simplex virus type 1 (HSV-1). Typically reactivation in immunocompetent patients Clinical - Common presentation: Fever, headache, seizures, ± viral prodrome - Polymerase chain reaction (PCR) of CSF: most accurate diagnosis (Sensitivity/specificity nearly 95-100%, false-negative can occur early after disease onset) - HSV-1 causes 95% of all herpetic encephalitis Imaging - Cortical, subcortical (relative white matter sparing) T2/FLAIR hyperintensity and swelling of limbic system (medial temporal, inferior frontal cortex, cingulate gyrus, insular cortex) with diffusion restriction - Typically bilateral, but asymmetric - Deep gray nuclei usually spared - GRE: If hemorrhagic, hypointensity "blooms" within edematous brain - T1WI C+: May see mild, patchy enhancement early. Gyriform enhancement usually seen 1 week after initial symptoms - late stage: atrophy, encephalomalacia Treatment intravenous acyclovir |
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