Chronic Necrotizing Encephalitis Involving Mainly the Grey Matter of the Temporo‐Rhinencephalic and Insular Regions

SUMMARY The authors reported an autopsy case of chronic necrotizing encephalitis.1 Clinical course: A male aged 34 years, complained of attack of loss of consciousness at age 31. Afterwards dysarthria, recent memory disturbance, polyphagia, and euphoria were noted. From age 33, spastic paresis of the four limbs, optic atrophy, dementia, and emotional incontinence appeared. At the advanced stage, the patient became comatose, died after a history of about three years three months. The CSF showed once, at an early stage, pleocytosis and increased total protein content. 2 Pathological findings: There was cortical necroses, which are obvious to the naked eye, localized in the insular and temporal lobes, cingulate and orbital convolutions of both hemispheres. The inferior parts of the third frontal convolutions were also involved. In these necrotic areas, compound granular corpuscles without a transport around the vessels were noted, while fibrous organization was absent. A slight to moderate perivascular infiltration was found in the insular, temporal cortex, claustrum and inner capsules. These lesions are known in the type of encephalitis described by van Bogaert under the name of acute necrotizing encephalitis. 3 The authors discussed the similarity and the difference of the clinico‐pathological features with protracted cases of van Bogaert's acute necrotizing encephalitis. They considered this as a case of chronic necrotizing encephalitis with the same topography of the lesions of acute necrotizing encephalitis.