Chronic Encephalitis

Abstract

In major epidemics of encephalitis lethargica it is estimated that about 25 per cent of the patients recover completely without sequelae.¹ Of the remainder some die, and the others develop neurological disorders of one sort or another. Not all of these patients show progressive degenerative changes in the striatal and parastriatal nuclei of the midbrain to the extent that severe parkinsonism develops. Furthermore, when one considers the diffuse damage to the gray matter of the brain, it is not surprising that certain patients develop bizarre disturbances of the sensory and motor functions of the body.

If the symptoms of the acute onset are characteristic of the lethargic or epidemic type of encephalitis, the neurological changes may be attributed to this disease with reasonable certainty. On the other hand, even though great care is used in the clinical study of any particular case, a long period of observation may be required before a proper diagnosis can be made. The following case is of a patient whose symptoms and physical signs were puzzling and who at first seemed to be headed for postencephalitic parkinsonism.

CASE REPORT

This case of chronic encephalitis is of considerable interest not only because it has been followed clinically for 20 years during which time the patient has married, raised three children, and has earned his living; but also because he has not showed the usual progressive changes in the basal ganglia and hypothalamic areas of the brain. Another important feature of this case has been the recent. . .