A 51-year-old man with seizures and progressive behavioral changes.
A 51-year-old man was admitted for evaluation of new-onset generalized seizures in the context of progressive and significant behavioral change. His medical history was only notable for previous outbreaks of genital herpes. He took no medications. He had occasional social alcohol use and no illicit drug use but was a 35-pack-year current smoker. The patient had no relevant occupational exposure history but had recently traveled to Panama. Initially, the patient's significant other noticed a progressive flattening of his affect. The patient then started to experience episodes of "passing out" that led to injuries prompting ED visits. He was prescribed antiseizure medications and scheduled for an outpatient workup. However, with progressive gait instability, lethargy, and an increase in frequency of generalized seizures, the patient was admitted for treatment of suspected viral encephalitis. Despite initiation of antimicrobial and antiviral therapy, the patient's level of alertness continued to decline, ultimately leading to intubation for airway protection.
Department of Internal Medicine, Mayo Clinic, Jacksonville, FL. Electronic address: Cable.Casey@mayo.edu.
Casey A
CA
Cable
Department of Neurology, Mayo Clinic, Jacksonville, FL; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL; Department of Critical Care, Mayo Clinic, Jacksonville, FL.
William D
WD
Freeman
Department of Neurology, Mayo Clinic, Jacksonville, FL.
Mark N
MN
Rubin
Department of Pathology, Mayo Clinic, Jacksonville, FL.
Andras
A
Khoor
Departments of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Lioudmila V
LV
Karnatovskaia
D003131:Combined Modality Therapy; D018450:Disease Progression; D004358:Drug Therapy; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D053609:Lethargy / Q000175:diagnosis / Q000209:etiology*; D020363:Limbic Encephalitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012640:Seizures / Q000175:diagnosis / Q000209:etiology*; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D007155:Immunologic Factors