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The patient was a 65 year old man who presented with a seizure after a three day prodrome of abdominal pain, odd smells, and low grade fever. Six weeks previously he had numbness and tingling of the right arm, face and leg which resolved.
CT scan performed at that time was normal. On admission, the temperature was
104 degrees F. Spinal fluid from tube #4 contained 113 WBC, 40 RBC, protein 97, and glucose 80.
He was treated empirically with acyclovir, and multiple blood and CSF cultures were negative.
On examination, the patient was awake and alert with good attention, a digit span of seven forward and four backward. His language was fluent and spontaneous, though he perseverated and confabulated. Comprehension of simple verbal commands and word repetition were normal. He was unable to name a wrist watch. Memory was intact to three of three objects at three minutes. He improved dramatically after a three week course of acylovir. Impaired renal function developed, presumed due to acyclovir.
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