What is the most common neurologic manifestation of cat scratch disease (CSD)?

Updated: Feb 16, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Encephalopathy is the most common neurologic manifestation, occurring in 2-3% of patients. This complication may be more common in adults than in children. The onset is usually abrupt and occurs 1-6 weeks after the lymphadenopathy becomes apparent.

Patients can become confused and disoriented, and their condition can deteriorate to coma. About 50% of patients have a fever. Focal findings of hemiparesis and reflex abnormalities may be noted. Seizures, which occur in as many as 80% of patients with neurologic sequelae, are often prolonged and recurrent.

The pathogenesis of encephalopathy is unknown, but it is not likely due to direct infection, because CSF is usually normal and recovery is rapid, often without antibiotic therapy. CT scans are often normal, and CSF examination shows mononuclear pleocytosis in 20-30% of patients. Electroencephalographs (EEGs) show nonspecific slowing. Recovery is usually complete in a 1 week or longer, but persistent neurologic deficits have been reported.

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