Viral infection in the central nervous system (CNS) is a common cause of seizures and epilepsy. Acute symptomatic seizures can occur in the context of almost all types of acute CNS viral infection. Secondary generalized seizures begin in one part of the brain, but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure. This file is designed by Mohammad saleh Moallem

1. Clinical manifestations
Miss Meili
A senior student 17-18 y/o
Case flowchart
With high physical activity
History & Origin Recurrence of disease Hospitalization Medical Examination Diagnose Treatment
Had optic neuritis
R. eye vision 4.6
Meili had optic neuritis at 15
years old and her right eye
vision was only 4.6. she has
been dancing since she was six.
Chilliness
Sore throat
Malaise
Myalgia
Her schedule often kept her up
late and she was sleep-deprived.
During one of the nights when
she was practicing suddenly
experienced the following
symptoms:
She continued physical activity
Uncontrollable twitching in right hand
Right upper extremity was twitching non-stop
Couldn’t lift her right hand and situation didn’t improved
Felt no strength in her right hand after the tics
At emergency department
The results of detailed physical examination:
T: 37.3°C, P: 100 beats/min,R: 26 beats/min,BP: 120/75 mm Hg. She
was conscious, attentive, and oriented; speech articulation was
competent; speech is clear and fluent with repetition, and
comprehension;grade one enlarged tonsil;breath sounds are clear
in both lungs; no wet or dry rales were heard. The muscle strength
of the right upper extremity was grade 2, the pathological signs
were negative, nuchal rigidity, three fingers from the chin to the
chest, and the Kernig's sign was positive.
After admission, the emergency physician gave further
examinations to find out the cause.
Preliminary diagnose: Neuromyelitis optica (NMO)
Head and cervical MRI
Chlorid: 2.6 mmol/L
Protein: 0.6 g/L
CSF was colorless and clear and opening
pressure and cell count were normal.
Physical and Lab. Examinations
After admission, the doctor gave
further examination to find out the
cause. These tests were done at first
time when patient came to hospital.
Differential
Diagnose
secondary
Viral
Meningitis
Ganciclovir
Viral meningitis is an infection of the membranes
and meninges that cover the brain and spinal
cord. A variety of viruses can cause meningitis,
including those that cause gastroenteritis,
measles, mumps, chicken pox, and herpes.
Ganciclovir and Carbamazepine
1. Ganciclovir
Following a week of treatment, Meili’s
condition gradually improved. Her body
temperature returned to normal, she had no
sore throat anymore, no limb twitching and
no cervical resistance. Kernig’s sign is
negative.
PBL2-2
Flowchart
4
June, 2022
Teacher
Prof. Cui Shuang 崔爽老师
Students
默汉 哈沙
莎格 索菲雅
阿朵 娜迪
约书亚 露华
艾里克
Saleh Harsha
Razy
Shaghayegh Saffiyah
Aliakbar
Nadia
Niloufar
JJ
李明
Abubakar
Medical history of patient gained by
emergency physician and the doctor
learned that she had optic neuritis at
15 years old.
Physical examination was
performed on her
HI
G
Lo
w
Viral infection in the central
nervous system (CNS) is a
common cause of seizures and
epilepsy. Acute symptomatic
seizures can occur in the context
of almost all types of acute CNS
viral infection.
It was recommended that she
continue to take carbamazepine and
other medications and closely
observe possible side effects, as well
as maintain regular follow-up visits.
Antiseizure drug-enhanced Na+ channel inactivation. They
prolong the inactivation of the Na+ channels, thereby
reducing the ability of neurons to fire at high frequencies.
Meili’s fellow students
rushed her to the hospital.
Her first thought was that she must
have caught a cold, so she took
BaiFuNing and antiviral oral liquid
but the symptoms were not relieved.
Auxiliary examinations: complete blood counts: white blood cell 9.0x10/L,
hemoglobin (HGB)130g/L, platelets (PLT) 180 x 109
/L, neutrophil ratio (NEU)
60%, erythrocytes 4.6 x 1012
/L, no abnormalities on chest X-ray. Result of the
EEG, suggesting mild to moderate abnormalities. No abnormalities in the
head CT scan.
The results of Auxiliary examinations:
Upon evaluating her
test results, she
was sent to the
neurology ward.
Several spikes and spike and slow-wave
complex were observed in the left frontal
region of the EEG, suggesting mild to
moderate abnormalities.
The MRI results indicated that the left
frontal lobe had abnormal long T1 and
long T2 signals, while the cervical
spine had no abnormal signals.
Lumbar puncture (CSF analysis)
Nor
Antibodies: None
Oligoclonal bands: 0 band
1. Positive Kernig’s sign
Severe stiffness of the hamstrings causes an inability to straighten the leg when the
hip is flexed to 90 degrees which is called as positive kenig’s sign; it’s one the main
symptoms of meningitis.
2. Grade 2 muscle strength
With Grade 2, patients can complete
movement in a horizontal plane
during muscle testing, however they
are unable to complete any type of
movement when gravity is applied.
3. Grade one enlarged tonsil Grade 1 means tonsillitis is barely visible.
epilepsy
Viral
meningitis
2. Carbamazepine
Ganciclovir is an antiviral. It is used to
treat infections caused by viruses.
Carbamazepine is a medicine to treat
epilepsy and nerve pain.
Prognosis
Three weeks later, Meili’s cerebrospinal fluid
returned to normal, and she was finally
discharged from the hospital.
1
st
day
2
nd
day