Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of herpes simplex encephalitis with hypersomnia and low orexin level in the cerebrospinal fluid

Akihiro Mukaino, M.D.1)2), Ikuo Kinoshita, M.D.1), Naomi Fukushima, M.D.1), Mayumi Otsubo, M.D.3) and Takashi Kanbayashi, M.D.4)

1)Section of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital
2)Present Address: Department of First internal medicine, The Nagasaki University School of Medicine
3)Section of Radiology, Japanese Red Cross Nagasaki Genbaku Hospital
4)Department of Neuropsychiatry Section of Neuro and Locomotor Scinence, Akita University School of Medicine

A 60-year-old woman suffered from high feveri38°Cjand abnormal behavior, was admitted to our hospital on the seventh day of the fever. At admission, she was stuporous, and a cerebrospinal fluid (CSF) analysis revealed pleocytosis (55/μl, monocytes). Fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images showed highintensity signals in the medial temporal lobe, inferior surface of the frontal cortex, right cerebellar vermis, and left thalamus. We diagnosed herpes simplex encephalitis, based on the finding of an elevated titer of herpes simplex virus antibody in the CSF (2.90). She was started on treatment with acyclovir and steroid pulse therapy, which was followed by rapid clinical improvement. After recovering from the stupor, the patient exhibited the symptoms of hypersomnia with low orexin level in the CSF. Thus, we should bear in mind that other than consciousness disturbance, patients with herpes simplex encephalitis can also present with rare complications due to the extent of the lesions.
Full Text of this Article in Japanese PDF (2647K)

(CLINICA NEUROL, 54: 207|211, 2014)
key words: herpes simplex encephalitis, hypersomnia, orexin in the cerebrospinal fluid

(Received: 20-Apr-13)