Generalized Polyspike Pattern in EEG Due to Aseptic Meningoencephalitis
Abstract
We report the electroencephalography (EEG) showing an intermittent generalized polyspike pattern in EEG due to an aseptic meningoencephalitis in a 71-year-old soporous patient. Initially, she presented with word-finding disturbances and later with generalized tonic-clonic seizures. The cerebrospinal fluid (CSF) showed pleocytosis of 99 leukocytes/μL (primarily neutrophils) and an increased protein level of 1240 mg/L (CSF/serum glucose ratio and lactate unremarkable). Pathogens and autoimmune antibodies in CSF were not found. Brain imaging was unremarkable. After antibiotic, antiviral and anticonvulsive therapy, the pattern in the EEG was no longer detectable. The patient was discharged to go home due to absence of any residues.
Full text
Ci a ion: Hobe , M.A.;
Da g ainiene, J.; Ma g a , N.G.
Gene alized Polyspike Pa e n in
EEG Due o Asep ic
Meningoencephali is. Diagnos ics
2023,13, 2569. h ps://doi.o g/
10.3390/diagnos ics13152569
Academic Edi o s: Ayman El-Baz
and F ank Webe
Recei ed: 2 July 2023
Re ised: 19 July 2023
Accep ed: 20 July 2023
Published: 2 Augus 2023
Copy igh : © 2023 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
diagnos ics
In e es ing Images
Gene alized Polyspike Pa e n in EEG Due o Asep ic
Meningoencephali is
Ma kus A. Hobe 1,* , Jus ina Da g ainiene 2and Nils G. Ma g a 1
1Depa men o Neu ology, Ch is ian-Alb ech Uni e si y o Kiel and Uni e si y Medical Cen e
Schleswig-Hols ein, 24105 Kiel, Ge many; n.ma g a @neu ologie.uni-kiel.de
2Ins i u e o Clinical Chemis y, Ch is ian-Alb ech Uni e si y o Kiel and Uni e si y Medical Cen e
Schleswig-Hols ein, 24105 Kiel, Ge many; [email p o ec ed]
*Co espondence: [email p o ec ed]
Abs ac :
We epo he elec oencephalog aphy (EEG) showing an in e mi en gene alized polyspike
pa e n in EEG due o an asep ic meningoencephali is in a 71-yea -old sopo ous pa ien . Ini ially,
she p esen ed wi h wo d- inding dis u bances and la e wi h gene alized onic–clonic seizu es. The
ce eb ospinal luid (CSF) showed pleocy osis o 99 leukocy es/
µ
L (p ima ily neu ophils) and an
inc eased p o ein le el o 1240 mg/L (CSF/se um glucose a io and lac a e un ema kable). Pa hogens
and au oimmune an ibodies in CSF we e no ound. B ain imaging was un ema kable. A e
an ibio ic, an i i al and an icon ulsi e he apy, he pa e n in he EEG was no longe de ec able. The
pa ien was discha ged o go home due o absence o any esidues.
Keywo ds: polyspike; asep ic meningoencephali is; elec oencephalog am
1
Figu e 1.
This elec oencephalog aphy (EEG) (10–20 sys em, sequen ial mon age, sensi i i y:
10
µ
V/mm, high equency il e s: 70 Hz, ime base: 15 mm/sec) showing an in e mi en gene alized
polyspike pa e n was ound in a 71-yea -old sopo ous pa ien due o an asep ic meningoencephali is.
Polyspikes (
A
) we e ollowed by del a wa es (
B
). Ini ially, he pa ien p esen ed wi h wo d- inding
dis u bances and la e wi h gene alized onic–clonic seizu es. The ce eb ospinal luid (CSF) showed
pleocy osis o 99 leukocy es/
µ
L (p ima ily neu ophils) and an inc eased p o ein le el o 1240 mg/L
(CSF/se um glucose a io and lac a e un ema kable, iden ical oligoclonal bands in se um and liquo ).
Pa hogens (Esche ichia coli, Haemophilus in luenzae, Lis e ia monocy ogenes, Neisse ia meningi-
idis, S ep ococcus agalac iae, S ep ococcus pneumoniae, Cy omegalo i us, En e o i us, He pes
simplex i us 1, He pes simplex i us 2, Va icella zos e i us, Cy omegalo i us, Human he pes i us 6,
Diagnos ics 2023,13, 2569. h ps://doi.o g/10.3390/diagnos ics13152569 h ps://www.mdpi.com/jou nal/diagnos ics
Diagnos ics 2023,13, 2569 2 o 3
Human pa echo i us, C yp ococcus neo o mans/ga ii, Tick Bo ne Encephali is i us and Bo elia
bu gdo e i) and au oimmune an ibodies (an ibodies agains amphiphysin, con ac in-associa ed
p o ein-2 [CASPR 2], collapsin esponse media o p o ein 5 [CRMP-5], gamma-aminobu y ic acid-b
[GABA b] ecep o , leucine- ich glioma inac i a ed 1 [LGI 1], Ma-p o eins, N-me hyl-D-aspa a e
[NMDA] ecep o , dipep idyl-pep idase-like p o ein 6 [DPPX], alpha-amino-3-hyd oxy-5-me hyl-
4-isoxazolep opionic acid [AMPA]- ecep o , Hu, Yo, Ri, glu amic acid deca boxylase [GAD] and
myelin oligodend ocy e glycop o ein [MOG]) we e no ound in CSF. Magne ic esonance imaging
(MRI) o he b ain wi h con as agen was un ema kable. The apy was conduc ed wi h le e i ace am
(2
×
1 g/die), lacosamide (2
×
100 mg/die), ce iaxone, ampicillin and acyclo i . A e clinical
imp o emen , he pa e n in he EEG was no longe de ec able. The CSF a e 8 days was no malized
(cell coun 3 leukocy es/
µ
L). The pa ien was discha ged o go home due o absence o any esidues.
Ten mon hs la e , he pa ien was examined in he ou pa ien clinic. She epo ed ha no seizu es
occu ed. The EEG was no mal wi h no epilep i o m discha ges. A polyspike pa e n in EEG ep e-
sen s in e ic al epilep i o m discha ges. I has been ound in di e en immunological and s uc u al
condi ions. Among hese a e encephali is wi h MOG-an ibodies [
1
] and wi h an i-ganglioside an i-
bodies [
2
] o Hashimo o encephalopa hy [
3
]. In gene al, EEG changes we e ound in pa ien s wi h
in lamma o y p ocesses in he b ain [
4
]. Slow wa es, epilep i o m discha ges and elec oencephalic
seizu es we e common in he pes encephali is [
5
]. In au oimmune encephali is, gene alized o ocal
slowing, epilep i o m discha ges and elec oencephalog aphic seizu es we e ound [
6
]. Up o 28%
o pa ien s wi h asep ic meningi is wi hou seizu es had gene alized and ocal slowing [
7
]. In he
epo ed case, no pa hogens o au oimmune an ibodies we e ound. B ain MRI also showed no
s uc u al changes. Howe e , conside ing he symp oms wi h epo ed and obse ed gene alized
onic-clonic seizu es [
8
], he clinical cou se wi h imp o emen a e ea men ini ia ion, and he
absence o he polyspike pa e n on EEG a e ea men ini ia ion, i is mos likely ha he polyspike
pa e n was associa ed wi h meningoencephali is. Al hough he cause o he meningoencephali is
(i.e., asep ic) was no ound in he case epo ed he e, neu ologis s should be awa e ha a polyspike
pa e n in EEG may be associa ed wi h an in lamma o y p ocess in he b ain. The e o e, app op ia e
diagnos ics should be pe o med i a polyspike pa e n is ound in he EEG.
Au ho Con ibu ions:
Concep ualiza ion, M.A.H. and N.G.M.; in es iga ion, M.A.H., J.D. and
N.G.M.; w i ing—o iginal d a p epa a ion, M.A.H.; w i ing— e iew and edi ing, J.D. and N.G.M.;
isualiza ion, M.A.H. All au ho s ha e ead and ag eed o he published e sion o he manusc ip .
Funding: This esea ch ecei ed no ex e nal unding.
Ins i u ional Re iew Boa d S a emen : No applicable.
In o med Consen S a emen :
The pa ien p o ided w i en in o med con en o publica ion o his
EEG eco ding and clinical in o ma ion.
Da a A ailabili y S a emen : No applicable.
Con lic s o In e es : The au ho s decla e no con lic o in e es .
Re e ences
1.
Ma u u, M.V.S.; Da la, A.V.; Ma u u, P.; Talla, V.B.; Dalai, S. Unila e al Au oimmune Encephali is: A Case Repo on a Ra e
Mani es a ion o Myelin Oligodend ocy e Glycop o ein An ibody Disease. Cu eus 2023,15, e34994. [C ossRe ] [PubMed]
2.
Daida, K.; Nishioka, K.; Takanashi, M.; Kobayashi, M.; Yoshikawa, K.; Kusunoki, S.; Yokoyama, K.; Ha o i, N. New-onse
e ac o y s a us epilep icus in ol ing he limbic sys em, spinal co d, and pe iphe al ne es. In e n. Med.
2020
,59, 267–270.
[C ossRe ] [PubMed]
3.
A ya, R.; Anand, V.; Chanso ia, M. Hashimo o encephalopa hy p esen ing as p og essi e myoclonus epilepsy synd ome. Eu . J.
Paedia . Neu ol. 2013,17, 102–104. [C ossRe ] [PubMed]
4.
Michael, B.D.; Solomon, T. Seizu es and encephali is: Clinical ea u es, managemen , and po en ial pa hophysiologic mechanisms.
Epilepsia 2012,53, 63–71. [C ossRe ] [PubMed]
5.
Sellne , J.; T inka, E. Seizu es and epilepsy in he pes simplex i us encephali is: Cu en concep s and u u e di ec ions o
pa hogenesis and managemen . J. Neu ol. 2012,259, 2019–2030. [C ossRe ] [PubMed]
6.
Pa el, A.; Meng, Y.; Najja , A.; Lado, F.; Najja , S. Au oimmune Encephali is: A Physician’s Guide o he Clinical Spec um
Diagnosis and Managemen . B ain Sci. 2022,12, 1130. [C ossRe ] [PubMed]
Diagnos ics 2023,13, 2569 3 o 3
7.
Pollak, L.; Klein, C.; Schi e , J.; Flech e , S.; Rabey, J.M. Elec oencephalog aphic abno mali ies in asep ic meningi is and
nonin ec ious headache. A compa a i e s udy. Headache 2001,41, 79–83. [C ossRe ] [PubMed]
8.
Fishe , R.S.; C oss, J.H.; F ench, J.A.; Higu ashi, N.; Hi sch, E.; Jansen, F.E.; Lagae, L.; Moshé, S.L.; Pel ola, J.; Roule Pe ez, E.; e al.
Ope a ional classi ica ion o seizu e ypes by he In e na ional League Agains Epilepsy: Posi ion Pape o he ILAE Commission
o Classi ica ion and Te minology. Epilepsia 2017,58, 522–530. [C ossRe ] [PubMed]
Disclaime /Publishe ’s No e:
The s a emen s, opinions and da a con ained in all publica ions a e solely hose o he indi idual
au ho (s) and con ibu o (s) and no o MDPI and/o he edi o (s). MDPI and/o he edi o (s) disclaim esponsibili y o any inju y o
people o p ope y esul ing om any ideas, me hods, ins uc ions o p oduc s e e ed o in he con en .