Coworker with onset of seizure , expressive aphasia

[Nursebeth57]

My closest coworker and friend is 28 years old. She recently was diagnosed with H.Phylori and began on the usual regimine of meds for this. She had been complaining of diffuse epigastric pain waking her at night for about a week prior to be diagnosed with HPylori. Three days after her doctor visit she complained of nausea and severe fatigue. The next day she experienced a seizure at home and has been in the hospital since. She is experiencing expressive aphasia and emotional outbursts. the doctors thought at first that she was suffering from prophyria(sp?) and then believed she had enchephalapthy. Her tests have come back negative for the prophyria, HSV, West Nile. her MRI shows inflammation in the frontal lobe, her CSF showed a WBC of 18,000 but her other blood work has been negative, including her CBC. It has now been 11 days and she cannot express herself and does not seem to recognize anyone. She laughs and she has outburst. She has gotten out of bed and gotten in the tub at midnight.
I was wondering if anyone could possibly shed some light on what may be going on with her? Her doctors are ready to send her home without any idea as to what has happened to her? She was on IV vancomycin for the first week and IV acyclovir. No steroids were ever given.
Any ideas? I am truly concerned as to what may have happened to her. She has no significant medical history and was not on any meds or illicet drugs. She has an 18 month old son. She is also a home health nurse and we have had no recent brain infections or odd cases.
Help???
Beth

[PaulMD]

Hi there.

I'm sorry to hear what happened to your friend.  From what you have described she is indeed suffering from a frontal lobe syndrome (emotional lability, unable to express herself, behavioral disturbances).  The real question is what is causing this affectation of the frontal lobe.  Most commonly these are vascular problems such as stroke but this is more common in the elderly or to those with heart and blood pressure problems.  For her age, the consideration of an infection seems most plausible.  The negative viral tests and the high WBC can mean that this could be a bacterial infection affecting the frontal lobe of the brain and the meninges.  The antibiotics and the acyclovir should help although there is no immediate relief from these drugs and we would just have to be patient and wait for the drugs to take effect.  I hope she gets well soon.  

Regards and God bless...

[Nursebeth57]

Thank you for your comments. I found out last night that they have sent her home. She is to follow up with speech and OT. She is off the vancomycin since being moved out of the unit on Sat and i am unsure as to whether or not she is still on acyclovir. I just know that the only diagnosis that they are giving out now is cerebritis. They said on Sat that they thought it was encephalitis, so i really don't know what is going on. i am just concerned that she will go home and no one will ever know what has caused this or if it will reoccur. Or if she will improve. It has been 11 days since she had her seizure, how long might something like this take to improve or will she fully recover?

Thank you for your help. All of us at work are just wondering if she will ever recover and is everything being done to help her.

Thanks for your time.
Beth