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What does this MRI report post viral encephalitis treatment indicate?

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Posted on Tue, 10 May 2016
Question: To whom it may concern,

My husband was diagnosed with viral encephalitis on the 11th January 2016 and was in ICU for 10 days then the general ward for the remainder of his stay until the 28th XXXXXXX He has recovered exceptionally well and the only thing that is different for him is his taste buds. However, these are slowly coming back.

He has his final lumbar puncture (he has had 3 since the illness started) on Saturday after completing his oral Acyclovir on the 16th Feb (he was on an IV for 21 days). He has no symptoms of the virus and his Consultant in Dubai is happy with his overall recovery. His CRP is also now down to 0.67 having been 248 during the acute phase of the illness. His lumbar results are also decreasing and we hope these will reflect the results of the CRP and the viral infection will be at 0 after Saturday's final test.

Conversely, his MRI scan shows: mild progression of the signal intensity changes in the right temporal and left front temporal regions, slight dilation of the right temporal horn denoting underlying atrophic changes of the right temporal lobe. There is no significant fluid restrictions in this study. There are no other issues.

At this stage the Consultant is unsure as to whether this is "fog" or scarring. Therefore, he is being kept on depakine (x1 daily) and keppra (x2 daily). He had 3 seizures on the 11th XXXXXXX prior to being medicated for encephalitis. His EEG on the 18th XXXXXXX showed no indications of seizures or epilepsy but the Consultant here advised that the anti-seizure drugs could've masked this. I didn't think this would be the case based on advice sort from other friends who are Drs and research I've carried out.

He had another lumbar puncture today, 27th Feb and the wbc is 27 thus a decrease since the last lumbar on the 6th Feb which showed a wbc of 38.

Overall, the Dr is unsure as to why there has been mild progression of this "fog" on his brain when he is absolutely normal in himself and no signs of the virus being present. One prognosis was that this may be his brains way of healing and if it's scarring, then scars change to fit the area damaged. I wanted to see if you could shed any light on this and perhaps give an insight into whether you have encountered this before as my husband's consultant has not.

I look forward to hearing from you soon.

XXXXX
doctor
Answered by Dr. Erion Spaho (35 minutes later)
Brief Answer:
Late MRI changes are a normal finding after encephalitis.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question, reviewed the image and understand your concerns.

About MRI findings of signal progression, in my opinion this is a normal finding in a person recovering from viral encephalitis.

In most of the cases of viral encephalitis initial ( or early ) MRI findings may be even negative ( in other words there are no signal abnormalities ) and later MRI-s could show changes that are mainly related to inflammatory processes around damaged areas of brain ( typically temporal lobes ).

Taste buds should return to normal function, so don't worry about this.

Epileptic seizures are mainly a clinical diagnosis and there are cases with seizures but without EEG changes mainly because of seizures arising from deep brain structures.

In conclusion, the most important thing is that your husband is recovering totally and this is the most important predictor of prognosis.

Hope you found the answer helpful.

I remain at your disposal for further questions and clarifications.

Take care.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Erion Spaho (36 minutes later)
Thank you for your response. It all seems logical. The Dr's in Dubai have not seen many cases like this. Have you seen cases like this?

The lumbar puncture today with the wbc is 27 has concerned us slightly as he completed his course of Acyclovir on the 16th Feb and we were hoping for a value of 0. Do you know why this is still the case? It's decreasing but I was concerned that without further anti-biotics this could get worse again and reactivate the illness. Is this normal? The Dr has said that this will continue to decrease.
XXXXXXX
doctor
Answered by Dr. Erion Spaho (3 hours later)
Brief Answer:
There's clinical improvement confirmed by tests too.

Detailed Answer:
Welcome back XXXXXXX and thanks for being on follow up.

I have been part of staff that evaluated and treated patients with encephalitis, some severe cases also.

Signs of antiinflammatory body response may last longer even though the viral infection is treated by antiviral drugs and virus absence.

Since clinically your husband is feeling better and inflammatory response is decreasing, the chances of recurrence are very low and you shouldn't worry much more than necessary.

Best thing to do in this moment is to continue close follow up with your husband's treating Doctor.

I agree with your husband's treating Doctor opinion about the decrease of the antiinflammatory signs.

Hope my responses were clear enough.

Take care.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Erion Spaho (15 hours later)
Thank you again Dr Erion for your response.

Finally, I just wanted to ask whether physical/sexual contact with him is now safe? I assume the answer will be yes as he no longer has symptoms of the virus.

Also, is he ok to lie in the sun? We are going away on honeymoon soon and I was concerned about this and also mosquitos. Conversely, I know his risk of encephalitis is now similar to mine and any one else.

Thank you.
doctor
Answered by Dr. Erion Spaho (2 hours later)
Brief Answer:
Normal life activities gradually.

Detailed Answer:
Welcome back.

Since your husband is recovering his health condition totally, gradually he can start to live the life normally including sexual activity.

About laying on sun, he can, but is better to avoid critical around noon hours, just as a precaution.

Mosquitos also are cause of concern because the possibility of transmitting certain infections, creams against mosquitos could be used to avoid them.

Hope this helps.

Best regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

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What does this MRI report post viral encephalitis treatment indicate?

Brief Answer: Late MRI changes are a normal finding after encephalitis. Detailed Answer: Hello and thanks for using HCM. I have read your question, reviewed the image and understand your concerns. About MRI findings of signal progression, in my opinion this is a normal finding in a person recovering from viral encephalitis. In most of the cases of viral encephalitis initial ( or early ) MRI findings may be even negative ( in other words there are no signal abnormalities ) and later MRI-s could show changes that are mainly related to inflammatory processes around damaged areas of brain ( typically temporal lobes ). Taste buds should return to normal function, so don't worry about this. Epileptic seizures are mainly a clinical diagnosis and there are cases with seizures but without EEG changes mainly because of seizures arising from deep brain structures. In conclusion, the most important thing is that your husband is recovering totally and this is the most important predictor of prognosis. Hope you found the answer helpful. I remain at your disposal for further questions and clarifications. Take care.