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August 1981

Tomography in Herpes Simplex

Author Affiliations

Department of Medicine
Department of Neurology Bowman Gray School of Medicine Wake Forest University 300 S Hawthorne Rd Winston-Salem, NC 27103

Arch Neurol. 1981;38(8):535. doi:10.1001/archneur.1981.00510080097022

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To the Editor.—  In the January 1981 issue of the Archives (1981;38:58-59), Greenberg et al reported on five patients with biopsy-proven herpes simplex encephalitis, with normal early cranial computed tomography (CT). Recently, we saw a similar case in which the CT remained normal throughout the course of the disease.

Report of a Case.—  On Feb 1, 1981, a 66-year-old man became confused and febrile. Confusion progressed, prompting admission to his local hospital. Studies included normal radionuclide brain scan and CT without infusion (Feb 9). An EEG revealed diffuse slowing. Cerebrospinal fluid was under normal pressure and was clear and colorless. Protein concentration was 79 mg/dL and glucose level was 75 mg/dL. Thirty-three RBCs per cubic millimeter and no WBCs were present. All stains and cultures were negative.Starting on the third day of illness, because of his progressive obtundation he received dexamethasone for six days. Because of intermittent fever, a

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