Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Could it be encephalitis? Hello. I just posted a follow-up question on my mothers condition. The doctors seem to think it may be encephalitis. The symptoms: during the first 2 weeks- stroke-like symptoms--slurred speech, numbness in her right arm and hand, horrible headaches, during the stroke-like spells (which lasted anywhere from 5 minutes to over an hour), an inability to answer simple questions like Where are you? and even the inability to speak. Within the past 4 weeks, the spells have lessened, her speech is improving but her short term memory is poor as well as her concentration. She also sleeps a tremendous amount of the time and is very excited at times in addition to quite a bit of vomiting. From what I've read these symptoms seem to be consistent with encephalitis. She's had CAT scans, brain wave tests, MRIs all of which came back showing nothing. She's also had 3 lumbar punctures which have shown elevated white blood cell counts, leading doctors to believe that a virus is causing the problem. Also, there is swelling of the brain. When I receive a response on 10/7/98 the doctor mentioned to possible categories of diseases: a mitochondrial disease called MELAS which may be diagnosed through DNA and Vasculitis type diseases which can be diagnosed using angiography of the cerebral vessels. I know that none of these tests have been performed. Please tell me, how would we be able to get these tests done on my mother. I am not a doctor, and I do not want to tell a doctor how to do his or her job, but I do believe that it can't hurt to check my mother for these diseases. No one has ever mentioned these tests before. If you have any suggestions, please let me know. Thank you, The symptoms and results you describe sound very typical of encephalitis, the swelling of the brain is a reaction to the infection, white cells in the spinal fluid are the most important diagnostic information as they point very strongly to an infection in the brain. Since encephalitis frequently infects the temporal lobes where speech and memory are procesed, short term memory and speech difficulties are very typical. Since this information has all come to light and you have a diagnosis which ties all of the features together I think that checking for vasculitis and MELAS is much less important than it was when the loose ends had not all been pulled together as they have now. If you still want to have the tests done there is no way to accomplish this without going through your doctor, or failing that another doctor. You should remember that angiography causes strokes in about 1% of people who have the test so it can actually hurt to do the test and there should be a clear need for further testing before proceeding with the test, I am not convinced that this need exists at this point. MELAS can be diagnosed by DNA testing, but can be screened for by testing the blood for high levels of lactic acid and also by muscle biopsy.
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