Abstract Details

Title Case Report of Cerebellitis as a Rare Manifestation of HSV Encephalitis

Topic Infectious Disease

Presentation(s) P2 - Poster Session 2 (2:45 PM-3:45 PM)

Poster/Presentation
Number 068

Objective To present as a case study of cerebellitis due to HSV CNS activation.

Background HSV is a common cause of encephalitis. A feared complication of HSV encephalitis is hemorrhage and necrosis of the brain parenchyma most commonly in the temporal lobe. Less common sites of focal necrosis include the insula and inferior frontal lobes. A rare presentation of HSV encephalitis is cerebellitis.

Design/Methods Not applicable.

Results A 74 year old female with a history of diabetes presented with 1 month history of progressive balance difficulty and dizziness. Neurological examination was remarkable for right eye ptosis (chronic) and ataxia. Serum laboratory evaluation was grossly unremarkable. MRI brain revealed diffuse swelling and T2 signal changes throughout the cerebellum, with associated left medial enhancement. CSF analysis by lumbar puncture was remarkable for elevated RBCs (WBCs 5, RBCs 438, protein 54.7, glucose 64) and HSV-1 PCR positivity. CSF autoimmune encephalopathy panel was ultimately negative. She was treated with acyclovir 10mg/kg q8h for 14 days and IV methylprednisolone 1000 mg daily for 5 days, which was transitioned to an oral prednisone taper. Shortly after treatment initiation, she exhibited clinical improvement of ataxia and dizziness, along with decreased cerebellar edema and enhancement on repeat MRI brain.

Conclusions Although rare, HSV encephalitis can manifest as cerebellitis. Recognition of atypical HSV encephalitis presentations is crucial as HSV-1 PCR is an effective inexpensive test to implement when a lumbar puncture is indicated. Rapid administration of acyclovir, accompanied by pulse-dose methylprednisolone, can result in symptomatic and radiographic improvement.

Authors/Disclosures
Cole M. Cimoch PRESENTER	Mr. Cimoch has nothing to disclose.
Daniel B. Groblewski, MD (Neurology Specialists of Jacksonville)	Dr. Groblewski has nothing to disclose.
David Mendoza, MD (HCA Florida Memorial Hospital)	Dr. Mendoza has nothing to disclose.

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