[Successful use of mild hypothermia therapy in an adult patient of non-herpetic acute encephalitis with severe intracranial hypertension].
A 41-year-old man was admitted to our hospital suffering from generalized convulsion with a high fever and disturbed consciousness one week after exhibiting flu-like symptoms. We made a diagnosis of acute viral encephalitis, based on the clinical features and the evidence of pleocytosis with an increase in protein in the CSF. On admission, MRI was normal and CRP was negative. The levels of transaminase, ammonia, and blood sugar were normal, so that an adult Reye's syndrome could be ruled out. Herpes simplex encephalitis and influenza encephalopathy were also ruled out because of viral examinations, and specific agents could not be determined. Clinical symptoms subsided once after he was treated with dexamethasone, acyclovir, and anti-convulsants, until generalized convulsion accompanied by a high fever again occurred on the 9th day. On the 18th day, the patient showed anisocoria and ataxic respiration due to severe brain edema. Mild hypothermia therapy to rectal temperature 35 degrees C was induced under mechanical ventilation. Cranial CT taken 3 days after the therapy began to show the improvement of the brain edema. After 7 days of the therapy, his clinical symptoms began to recover dramatically. On the 46th day, he was discharged from hospital without showing almost any neurological symptoms. Mild hypothermia therapy should be considered for adult patients as well as non-adult patients suffering from acute encephalitis with severe intracranial hypertension.
Fujita
Nobuya
N
Department of Neurology, Nagaoka Red Cross Hospital, Terashima 287-1, Nagaoka, Niigata 940-2085, Japan.
Saito
Hiroshi
H
Sekihara
Yoshio
Y
Nagai
Hiroko
H
D000208:Acute Disease; D000328:Adult; D001929:Brain Edema / Q000209:etiology*; D004660:Encephalitis / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D019586:Intracranial Hypertension / Q000209:etiology*; D008297:Male