Re: Could it be encephalitis?

Posted By CCF neuro MD MM on October 18, 1998 at 18:39:55:

In Reply to: Could it be encephalitis? posted by Renee G on October 18, 1998 at 16:17:00:






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.