Herpes encephalitis presenting as mild aphasia: case report.
BACKGROUND
Encephalitis presenting as a change in mental status can be challenging to recognize in the primary care setting. However, early detection via a low threshold of suspicion can be useful, leading in turn to early treatment and improved survival.


METHODS
We present a case which we consider relevant to primary care practitioners. The patient in question presented with relatively mild mental status changes, progressing to confusion, dysnomia and delirium over a period of three days. While infection did not appear to be the leading cause on her differential diagnosis, she was found on extensive workup to have encephalitis caused by Herpes Simplex Virus type 1.


CONCLUSIONS
The case is instructive for general practitioners and other clinicians to maintain vigilance for central nervous system (CNS) infections which may present atypically.
Department of Family Medicine, University of Vermont, Burlington, Vermont 05405, USA. omar.khan@vtmednet.org
Omar A
OA
Khan
Allan
A
Ramsay
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001037:Aphasia / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D018450:Disease Progression; D004636:Emergency Service, Hospital; D020803:Encephalitis, Herpes Simplex / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D018259:Herpesvirus 1, Human / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016133:Polymerase Chain Reaction
D000998:Antiviral Agents; D000212:Acyclovir