LAUSR

The 16-year-old patient J.P. was ill for five days with fever (maximum 38.9 °C, 38.2 °C on the day before), bipolar headache, nausea, and vomiting twice. No further signs of infection, pretreatment with paracetamol and ibuprofen. J.P. had hardly eaten, but still drunken enough. On admission, J.P. cmplained of bifrontal headache and nausea, but was well-oriented. Motor movement and sensitivity normal, muscles normoton. No meningitic signs, no ataxia, proper reflexes of the muscles triggerable identically on both sides. Temp. 36.4 °C, RR 112/67 mmHg, Hf 69 beats/min, oxygen saturation 96%. Laboratory chemistry: no relevant increased inflammation parameters. No meningism in multiple examination by pediatric consultants in the following one and a half days. An increase in headaches, an unclear change in the personality of the patient, retarded reactions (“always very reserved and sparing of words”), an MRI of the head was performed, showing a typical encephalitis picture with haemorrhagic temporal lobe encephalitis, as is often observed in HSV encephalitis. After lumbar puncture, we immediately began acyclovir therapy. At times very severe headaches were treated parenterally with metamizole and piritramide. The personality changes increased in the first few days. The patient was initially only limited oriented (knew, for example, that we had the first day of the week, but not that this is the Monday, knew that his sisters had visited him on the previous day and could distinguish them by telling the place of their residence, but did not know their names) and was significantly slowed down. The symptoms slowly decreased somewhat from the 6th day of treatment onwards. After 11 days there was still pronounced memory and word-finding disorder, slight disorientation and attention deficits. An inpatient early rehabilitation was organized, but by J.P. rejected it after extensive discussions. With the consent of his parents he wished a long-term outpatient rehabilitation, which was organized in co-operation with the health insurance, the parents and the therapists working in the county. In addition to pediatric support, this included physiotherapy on a neurophysiological basis, speech therapy and occupational therapy. In the further course the general condition improved, the personality disorder regressed and the word-finding disturbances also improved. The thorough neuropsychological assessment before dismissal showed disturbances in the area of memory, attention, visual perception and executive functions, in spite of the overall improvement. After 3 1/2 weeks, J.P. In good general condition and subjectively free of complaints in the further outpatient rehabilitation. Parallel to this J.P. attended his previous school class, and after a few months in the following summer he passed the final exams of the school (Fachoberschulreife/Realschulabschluss). The diagnostic measures are presented in the clinical context: MRI at the beginning, after 4 weeks, after 3 and 7 months EEG Neuropsychological testing before rehabilitation and after 6 months.