<Case Reports>Echovirus encephalitis exhibiting an alternating electroencephalographic pattern in the early stage

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We report a case of viral encephalitis (echovirus, serotype 11), in which diagnosis was established by noting the pleocytosis of mononuclear cells and the rise of serum antibody titer (hemagglutination-inhibition test) for the virus. The patient was a 32 year-old woman who suddenly presented in a confused state (Amentia, in German technical terms) after manifesting neurotic symptoms, such as anxiety and sensitivity, for 2 weeks. Although she was comatose at the worst stage, there was no cardiac or respiratory distress, general convulsion, stiffness in the neck or Kernig's sign. In the electroencephalograms (EEG) recorded in the early stage while she was transiently immobile and in a confused state, each group of low-to-middle amplitude β-waves, middle amplitude β-waves, and middle-to-high amplitude slow α-waves and θ-waves appeared diffusely and alternately. In the present case, the phenomenon of the alternating EEG pattern suggests possible involvement of the midbrain and diencephalon, in which the ascending reticular formation activates or regulates the level of consciousness.
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