A case of enteroviral meningoencephalitis presenting as rapidly progressive dementia.
BACKGROUND
A 70-year-old immunocompetent male presented to a memory disorders clinic with a 7-month illness that had begun with somatic complaints including transient right temporal head pain, left buttock pain, and right conjunctival injection. About 3 months after the first signs of illness, the patient had begun to develop insidious cognitive and behavioral decline, which progressed most rapidly in the 2 months before presentation. An assessment completed during hospitalization for intermittent fevers and confusion had not revealed an infectious etiology, although mild pleocytosis in the cerebrospinal fluid had been noted. Upon presentation to the memory disorders clinic, the patient was disoriented, distractible, laughed at inappropriate moments, and followed only one-step commands. He had hypophonic speech and had mildly increased axial tone. He scored 5 out of 30 on the Mini Mental State Examination and was admitted for expedited evaluation.


METHODS
Physical examination, brain MRI, electroencephalogram, lumbar puncture, autoimmune and paraneoplastic testing, cerebral angiogram, cerebrospinal fluid analysis, enterovirus group-specific reverse transcriptase polymerase chain reaction assay, and RNA sequencing in brain biopsy samples.


METHODS
Enteroviral meningoencephalitis.


RESULTS
Intravenous steroids with oral taper and intravenous immunoglobulin.
Valcour
Victor
V
Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA94143, USA. vvalcour@memory.ucsf.edu
Haman
Aissa
A
Cornes
Susannah
S
Lawall
Carson
C
Parsa
Andrew T
AT
Glaser
Carol
C
Yagi
Shigeo
S
Tihan
Tarik
T
Bhatnagar
Julu
J
Geschwind
Michael
M
D000368:Aged; D003704:Dementia / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D003937:Diagnosis, Differential; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D013256:Steroids / Q000627:therapeutic use
D013256:Steroids