The neurologic complications of cat-scratch disease in 76 patients with an average age of 10 years are reported from the Jackson-ville Health Education Program, University of Florida, and Department of Pediatrics, Uniformed Services, Bethesda, MD. The incidence of encephalopathy varied from 0.17%-2% in two groups of patients examined. Convulsions occurred in 28 (46%) of 61 patients, and combative behavior occurred in 39% of those who were semi-conscious during the recovery phase of a convulsive episode. Headache, lethargy and malaise were common and persistent. Less common findings were ataxia, bilateral VI nerve palsy, aphasia, transient hemiplegia, and profound hearing loss lasting eight months. Of 15 patients without encephalopathy two had facial nerve paresis, ten neuroretinitis, and three peripheral neuritis. All 76 patients recovered within 12 months and 78% recovered within 1-12 weeks. There were no neurologic sequelae. Treatment with antibiotics and prednisone is usually ineffective. The authors recommend IV Gentamycin in severely ill patients. [1]
COMMENT. Cat-scratch disease encephalopathy should be considered in a young patient presenting with sudden onset of coma and/or convulsions. The patient should be examined for lymphadenopathy and inoculation papule or conjunctival granuloma. The diagnosis can be confirmed by a cat-scratch skin test. The differential diagnosis includes Lyme encephalitis, drug intoxication, viral or bacterial infections, and Reye’s syndrome.