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Neurocritical Care

, Volume 19, Issue 1, pp 111–115 | Cite as

Successful Management of Severe Neuroinvasive Eastern Equine Encephalitis

  • Linda C. Wendell
  • N. Stevenson Potter
  • Julie L. Roth
  • Stephen P. Salloway
  • Bradford B. Thompson
Practical Pearl

Abstract

Background

Eastern Equine Encephalitis (EEE) virus is an arbovirus that mostly causes asymptomatic infection in humans; however, some people can develop a neuroinvasive infection associated with a high mortality.

Methods

We present a case of a patient with severe neuroinvasive EEE.

Results

A 21-year-old man initially presented with headache, fever, and vomiting and was found to have a neutrophilic pleocytosis in his cerebrospinal fluid. He eventually was diagnosed with EEE, treated with high-dose methylprednisolone and intravenous immunoglobulin. His course in the NeuroIntensive Care Unit was complicated by cerebral edema and intracranial hypertension, requiring osmotherapy, pentobarbital and placement of an external ventricular device, and subclinical seizures, necessitating multiple anti-epileptic drugs

Conclusions

A multifaceted approach including aggressive management of cerebral edema and ICP as well as treatment with immunomodulating agents and cessation of seizures may prevent brain herniation, secondary neurologic injury and death in patients with EEE. Effective management and treatment in our patient contributed to a dramatic recovery and ultimate good outcome.

Keywords

Eastern Equine Encephalitis Intracranial hypertension Cerebral edema Seizure 

Notes

Disclosure

None.

References

  1. 1.
    Centers for Disease Control and Prevention (CDC). West nile virus disease and other arboviral diseases—United States, 2011. MMWR Morb Mortal Wkly Rep. 2012;61:510–4.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention (CDC). West Nile virus disease and other arboviral diseases–United States, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(30):1009–13.Google Scholar
  3. 3.
    Deresiewicz RL, Thaler SJ, Hsu L, Zamani AA. Clinical and neuroradiographic manifestations of eastern equine encephalitis. N Engl J Med. 1997;336(26):1867–74.PubMedCrossRefGoogle Scholar
  4. 4.
    Tunkel AR, Glaser CA, Bloch KC, et al. The Management of Encephalitis: clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47(3):303–27.PubMedCrossRefGoogle Scholar
  5. 5.
    Gaieski DF, Nathan BR, Weingart SD, Smith WS. Emergency neurologic life support: meningitis and encephalitis. Neurocrit Care. 2012;17(Suppl 1):S66–72.PubMedCrossRefGoogle Scholar
  6. 6.
    Ropper AH, Gress DR, Diringer MN, Green DM, Mayer SA, Bleck TP. Neurological and neurosurgical intensive care. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2004.Google Scholar
  7. 7.
    Whitley RJ, Alford CA, Hirsch MS, et al. Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med. 1986;314(3):144–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Barnett GH, Ropper AH, Romeo J. Intracranial pressure and outcome in adult encephalitis. J Neurosurg. 1988;68(4):585–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Baussart B, Cheisson G, Compain M, et al. Multimodal cerebral monitoring and decompressive surgery for the treatment of severe bacterial meningitis with increased intracranial pressure. Acta Anaesthesiol Scand. 2006;50(6):762–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Ziai W, Lewin J III. Update in the diagnosis and management of central nervous system infections. Neurol Clin. 2008;26(2):427–68.PubMedCrossRefGoogle Scholar
  11. 11.
    Golomb MR, Durand ML, Schaefer PW, McDonald CT, Maia M, Schwamm LH. A case of immunotherapy-responsive eastern equine encephalitis with diffusion-weighted imaging. Neurology. 2001;56(3):420–1.PubMedCrossRefGoogle Scholar
  12. 12.
    Xu X, Bergman P, Willows T, et al. CMV-associated encephalitis and antineuronal autoantibodies—a case report. BMC Neurol. 2012;12(1):87.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Linda C. Wendell
    • 1
  • N. Stevenson Potter
    • 1
  • Julie L. Roth
    • 2
  • Stephen P. Salloway
    • 3
  • Bradford B. Thompson
    • 1
  1. 1.Departments of Neurology and NeurosurgeryRhode Island Hospital/Warren Alpert School of Medicine at Brown UniversityProvidenceUSA
  2. 2.Department of NeurologyRhode Island Hospital/Warren Alpert School of Medicine at Brown UniversityProvidenceUSA
  3. 3.Departments of NeurologyButler Hospital/Warren Alpert School of Medicine at Brown UniversityProvidenceUSA

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