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PP111

48-YEAR-OLD WOMAN WITH MENINGOENCEPHALITIS HERPETIC AND LANGUAGE IMPAIRMENT

Monday, 28 May, 2012 - 13:35
Board 2

  

48-YEAR-OLD WOMAN WITH MENINGOENCEPHALITIS HERPETIC AND LANGUAGE IMPAIRMENT   INTRODUCTION: Show the case of a woman with sensory aphasia in connection with a herpetic meningoencephalitis.    PURPOSE: Describe the specific language impairment and the characteristics of the herpetic meningoencephalitis just as the importance of early diagnosis through a clinical case as an example.    MATERIAL AND METHODS: This is a 48 year old woman, administrative assistant, with clinical onset of fever, headache, vomiting and decreased level of consciousness. Due to the situation of the patient, she was admitted in Intensive Care Unit. Diagnosis was herpetic meningoencephalitis through the clinic and additional tests: ØBrain computed tomography: no significant alterations. ØElectroencephalogram: drawing diffusely slowed. Focal left temporal slow activity. ØMRI: involvement of the limbic system with the left temporal lobe swelling. (View images) ØCerebrospinal fluid serology: positive for herpes simplex virus. She was treated with Acyclovir, steroids and phenytoin. A week later she was transferred to the Infectious Disease Service, in this service, the patient remained stable, with a favourable clinical outcome. Due to the existence of a sensory aphasia, she was valued for us. As for the phoniatric exploration the patient showed transcortical sensory aphasia with good linguistic reservations. The Boston test revealed the existence of fluent speech with anomia and inability to understand words by visual confrontation with repetition of phrases and words preserved reading. We taught her guidelines to communicate with her family and with other people and she was included in speech therapy in our Unit.    RESULTS: After treatment with speech therapy, the patient progressed  favorably, developing a fluid and expressive language, with articulation and structure of normal language, although with great difficulty for nominal evocation and a component of mnesic alteration.    CONCLUSIONS: If a patient presents a probable differential diagnosis herpes encephalitis should always be started as early as possible specific treatment with Acyclovir, because of the prognosis of patients with early and delayed treatment is radically different. Clinical manifestations of herpex simplex meningoencephalitis include impairment of consciousness, fever, and the existence of a focal neurological deficit such as aphasia, hemiparesis and/or hemianopia. Cognitive deficits are more frequent and more severe than those found in other encephalitis. These deficits can be difficult to be diagnosed, even with the Mini-mental test, requiring specialized neuropsychological studies. Herpes simplex infections have a predilection for the limbic structures of the temporal lobes and fronto-orbital regions, which explains the existence of sensory aphasia and  memory impairment. Amnesia is similar to that described in Korsakoff´s Syndrome, although in the encephalitis the semantic memory appears to be altered to cause more damage in the side areas of the temporal lobes. The anomie caused by the encephalitis appears to be a category-specific semantic impairment, with a disproportionately severe impairment in the naming of animate objects.
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