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Help Deteriorating mental state

sarafian sarafian at inter.net.il
Fri Feb 5 09:17:46 EST 1999

Dear persons

We have a patient with some kind of encephalopathy/encephalitis. The
patient is a 27 year old women, having Crohn's disease since 13 years. She
was under home TPN for one year till two years ago, and then she under went
total colectomy and ileostomy. Since then the Crohn was not active and she
did not take any medication. About a month ago she had fever and URTI. Then
she started to suffer from head ache and dizziness and she became confused,
so, she was hospitalized. The patient was dysoriented and could not make
simple calculation. She had pyramidal signs and her EEG was pathologic
(FIRDA), her brain CT was normal, but MRI showed hyperintence lesions in
the white matter. The CSF showed elevated protein (74) and no cells. There
were no bacteria nor fungi, and PCR for Herpes was negative. All vitamins
were normal and so were all trace elements. Nevertheless, the patient was
given all B vitamins, trace elements and acyclovir, with no improvment.
Then she was given high dose metylprednisolon, for one week, but her
condition became worse. She is now precomatous and we intend to make a
brain biopsy. 
What can possibly be the diagnosis ?? Is there anything else we can
investigate ??

Thank you very much
Answer to  sarafian at inter.net.il

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