ABSTRACT
A 66-year-old man was admitted to our hospital with muscle pain, fatigue and appetite loss that had lasted for a month. The patient was somnolent and had nuchal stiffness with a high fever. Cerebrospinal fluid (CSF) tests demonstrated lymphocytic pleocytosis with a decreased CSF-blood glucose ratio. The tests for tuberculous, fungal and carcinomatous meningitis and herpetic meningoencephalitis were negative. Endocrinological exams showed hypopituitarism and diabetes insipidus. A pituitary MRI showed an enlargement of the pituitary stalk. A diagnosis of lymphocytic hypophysitis with aseptic meningitis was made after the exclusion of secondary hypophysitis. Lymphocytic hypophysitis with aseptic meningitis can mimic subacute meningoencephalitis.
Subject(s)
Meningitis, Aseptic/diagnosis , Meningitis, Aseptic/epidemiology , Meningoencephalitis/diagnosis , Pituitary Diseases/diagnosis , Pituitary Diseases/epidemiology , Aged , Comorbidity , Diabetes Insipidus/diagnosis , Diagnosis, Differential , Humans , Hypopituitarism/diagnosis , Magnetic Resonance Imaging , Male , Pituitary Gland/pathology , Pituitary Gland/physiopathologyABSTRACT
A 62-year-old woman presented with difficulty in speaking and difficulty in opening her eyes. A neurological examination revealed progressive nonfluent aphasia (PNFA), apraxia of eyelid opening, supranuclear vertical gaze palsy, and mild asymmetric rigidity. The diagnosis was difficult to establish because of unusual clinical features, and progressive supranuclear palsy (PSP) was considered. The results from recent studies suggest a positive association between PNFA and a diagnosis of corticobasal degeneration (CBD) or PSP, even in mild parkinsonism cases. The overlapping clinical, genetic, and pathological features of CBD and PSP have also been recently recognized. However, in Japan, there have been few reports evaluating the clinical features of CBD or PSP accompanied by primary progressive aphasia. We report the case of our patient and compare the clinical features of our patient with those of Japanese patients with CBD or PSP accompanied by primary progressive aphasia; moreover we discuss clues that can lead to the correct clinical diagnosis of patients with primary progressive aphasia and parkinsonism comorbidities.