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Severe presentation of antibody-negative, postinfectious steroid-responsive encephalitis and atonic bladder after herpes simplex encephalitis
  1. Luay Mrad,
  2. Argirios Moustakas,
  3. Robert Fuino and
  4. Waqar Waheed
  1. Department of Neurological Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
  1. Correspondence to Luay Mrad, luay.mrad{at}


A 75-year-old woman presented with new onset of confusion, intense episodic dizziness and formed visual hallucinations. Herpes simplex encephalitis and non-convulsive temporal lobe seizures were confirmed with cerebrospinal fluid (CSF) and electroencephalography testing. In addition, her hospital course was complicated by syndrome of inappropriate antidiuretic hormone secretion and atonic bladder contributing to an episode of urinary tract infection. After completing 3 weeks of acyclovir treatment, the patient became obtunded with right arm choreiform movements and persistent inflammatory CSF findings not attributable to persistent herpes simplex virus infection or other confounding factors. The patient responded to steroid treatment. Repeated autoimmune and paraneoplastic evaluations were negative. Both clinical (cognitive testing and atonic bladder) and CSF inflammatory finding improved in the follow-up period.

  • neurology
  • clinical neurophysiology
  • epilepsy and seizures
  • immunology
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  • Contributors LM: collected the date including the history of present illness, workup, treatment and follow-up, collected the EEG images and write the description, obtained patient’s consent, wrote the paper, wrote the abstract and submitted the paper. RF: reviewed and edited the discussion and introduction parts of paper, write the mechanism of action of acyclovir and discussion of neurological deficits in post HSE patient (images 3 and 4), helped with final edition of abstract and paper. AM: reviewed and edited the description of EEG images, reviewed and edited the discussion part of paper and helped with final edition of abstract and paper. WW: reviewed and edited the paper, reviewed and edited the data including history of present illness, workup and follow-up, reviewed and edited images 3 and 4, reviewed and edited the abstract, provide guidance to writing and organising the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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