Rapidly fatal encephalitis associated with atypical lymphoid proliferations of the basal ganglia subsequent to aneurysmal subarachnoid hemorrhage

  • Ayesha Kar Virginia Tech Carilion School of Medicine, Roanoke, United States.
  • Evin L. Guilliams Virginia Tech Carilion School of Medicine, Roanoke; Carilion Clinic, Section of Neurosurgery, Roanoke; Virginia Tech School of Neuroscience, Blacksburg; Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States.
  • Joshua A. Cuoco Virginia Tech Carilion School of Medicine, Roanoke; Carilion Clinic, Section of Neurosurgery, Roanoke; Virginia Tech School of Neuroscience, Blacksburg; Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States.
  • Eric A. Marvin | eamarvin@carilionclinic.org Virginia Tech Carilion School of Medicine, Roanoke; Carilion Clinic, Section of Neurosurgery, Roanoke; Virginia Tech School of Neuroscience, Blacksburg; Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States.

Abstract

Rapidly fatal encephalitis associated with atypical lymphoid proliferations after intracranial aneurysm rupture has not been reported. Here, we describe a 52-year-old female who presented to the emergency department with a severe headache. Imaging demonstrated aneurysmal subarachnoid hemorrhage due to a ruptured left posterior inferior cerebellar artery aneurysm, which was treated with endovascular embolization and subsequent external ventricular drain. She recovered without neurologic sequelae by day seven; however, five weeks later she represented with a severe headache associated with nausea and fever. Initial repeat imaging was unremarkable. She deteriorated quickly and was empirically treated for meningitis despite negative cerebrospinal fluid studies. Magnetic resonance imaging revealed diffuse cerebral edema within the basal ganglia and thalamus. Biopsy of the caudate nuclei revealed atypical lymphoid proliferations. She was treated accordingly with no significant improvement. This case highlights the necessity for a better understanding of the etiology, chronology, and natural history of atypical lymphoid proliferations.

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Published
2019-11-11
Section
Case Reports
Keywords:
Atypical lymphoid proliferations, Encephalitis, Subarachnoid hemorrhage, Aneurysm
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How to Cite
Kar, A., Guilliams, E., Cuoco, J., & Marvin, E. (2019). Rapidly fatal encephalitis associated with atypical lymphoid proliferations of the basal ganglia subsequent to aneurysmal subarachnoid hemorrhage. Clinics and Practice, 9(4). https://doi.org/10.4081/cp.2019.1187