8/25/16 AM Report – VZV Encephalitis

CSF Study Interpretation:

CSF Studies:
Normal Bacterial Meningitis Viral Meningitis Fungal/TB
Opening Pressure (cm H2O) < 15 ↑↑ Normal/mild ↑ Variable (very elevated with crypto)
Protein (mg/dL) 15-45 Normal/mild ↑
Glucose (mg/dL) 40-70 Normal
WBC 0-8 ↑↑ (>1000) ↑ (5-300)
WBC differential Even >80% PMNs >50% Lymphs, <20% PMNs 50-80% Lymphs
Gram Stain Normal 60-90 % + N/A 37-87% AFB +

CT Before LP:
1) Altered Mental Status / Fecal Deficits
2) Immunocompromised
3) History of CNS disease – mass lesion, stroke, etc.
4) Seizure within 1 week of presentation
5) Papilledema

Bad causes of headache to always think about:
– Meningitis (or other CNS infection)
– Tumor/Space occupying lesion
– Temporal arteritis

Headaches: POUNDPulsatile, One day, Unilateral, Nausea, Disabling
Epi: 3x more common in adult females; peaks in the 5th decade of life
S/S: unilateral, throbbing headache, +/- photophobia/phonophobi/nausea

Tension-Type Headache
Epi: stress/sleep disruption are common triggers
S/S: bilateral, steady, mild-moderate discomfort

Cluster Headache:
Epi: male sex/tobacco use are risk factors; typically occurs within a few hours of falling asleep
S/S: periorbital/temporal intense pain usually ipsilateral; can develop autonomic features such as ptosis, lacrimation, conjunctival injection, and rhinorrhea

Clinical Manifestations of VZV:
Rash: erythematous papules progressing to grouped vesicles; usually limited to one dermatome, but can affect 2-3 neighboring dermatomes. Thoracic/Lumbar dermatomes are most commonly involved.
Acute neuritis: most common symptom; 75% have prodrome of pain – usually described as “burning, throbbing, stabbing.”

HZ Ophthalmicus:
serious, sight-threatening condition caused by VZV reaction within trigeminal ganglion. Usually preceded by prodrome of headache, malaise, fever.
Hutchinson’s Sign:
vesicles on the tip of the nose – associated with HZ opthalmicus.
Ramsey-Hunt Syndrome: major otologic complication of VZV reactivation.
Triad (typicially) 1) Ipisilateral facial paralysis
2) Ear pain
3) Vesicles in auditory canal

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