David Munoz is a neuropathologist at Unity Health Toronto, St. Michael’s Hospital


David G Munoz, Agnes Supala-Berger, Julian Spears, Suradech Suthiphosuwan.Unity Health, Toronto


A previously healthy Caucasian 71-year-old woman presented in May 2019 with acute development of nausea and vomiting, refractory seizures, and left arm paresis and neglect, accompanied by obtundation. She recovered in one month, but was readmitted in December 2021 with rapid onset agitation, disorientation, and dysphasia, and right homonomous hemianopsia. EEG in both admissions showed right hemispheric focal status epilepticus. CT scan showed edema and sulcal effacement involving left occipital and posterior temporal lobes, along with periventricular hypodensity. MRI revealed left hemisphere FLAIR hyperintensity consistent with encephalitis. CSF showed 11 nucleated cells, predominantly lymphocytes, protein 0.64 mg/mL, glucose 4.mmol/L Paraneoplastic work-up and search for malignancy were negative. She was treated with IV prednisolone and acyclovir and gradually improved clinically. However, on MRI cortical hyperintensity, gyral swelling, and subcortical white matter hyperintensity progressed. There is a family history of dementia in her father and brother. On February 7th she underwent a left parietal biopsy

Discussion points

  1. Diagnosis
  2. Additional tests
  3. Relevance of ethnicity