viral meningitis/encephalitis

[Melanie0220]

My best friend has been diagnosed with viral meningitis/encephalitis.  She presented to the ER with a severe headache and fever.  She had a spinal tap done and was diagnosed with viral meningitis.  While staying at her local hospital with spiked fevers and altered mental status she then suffered a seizure on her fifth night.  Immediately transferred her to the unit and then transferred to another hospital for more critical care.  She has now been unresponsive for 14 days.  She does respond (does not open eyes) to painful stimuli but it does seemed delayed.  There seems to be weakness on the left side as well.  She has still not been diagnosed with a cause of the virus.  Her MRIs and EEGs have come back unremarkable.  Her WBC CSF count is 151.  It has come down 11.  She is being treated with antiviral, antibacterial, antifungal medications.  She looks as if she is in a very deep sleep.  Respirations, Heart rate, BP are in normal limits along with oxygenation.  She recently had a feeding tube put in and has a PIC line.  She has been tested for lymes, west nile, and that came back negative.  Doctors are now trying to decide to do a brain biopsy.  What will this determine?  What is the risk?  They seemed to think that she should wake up but she has not.  Is there anything that you could recommend and what is the probable prognosis?
Thanks for your help

Melanie

[Melanie0220]

Follow up question.

My friend had dialysis today.  We were told that unknown antibodies were detected in lab work and that they would perform dialysis to filter out these antibodies to see if this would help my friend wake up.  Have you ever heard of any instances of this.  Also, she will be having surgery tomorrow to remove 2-3 cm of tissue from the temporal lobe.  This will then be sent to the CDC to be tested to see if they can find out what is causing the infection.  What is your take on this and will there be any function loss due to the amount of tissue taken and how long do you think it would take to get back results?

Thanks

Melanie

[PaulMD]

Hi.

From what you have described, this could really be a viral infection of the brain and meninges.  The problem is, these infections can really take sometime to fully resolve, and even if resolved, there can be residual symptoms and lasting sequelae.  

Treatment is mainly supportive (supporting the respiration, feeding, etc) while the brain recovers.

Brain biopsy is indicated if the doctors are having second thoughts about the diagnosis.  Risks would include bleeding, further neurologic deterioration, and even progression to deep coma (these should be discussed with her doctors fully).