Herpes varicella zoster encephalitis in immunocompromised patients

An unusual case of varicella zoster encephalitis mimicking a glioblastoma on magnetic resonance imaging and magnetic resonance spectroscopy

The authors report a case of varicella zoster encephalitis, mimicking a glioblastoma on Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS). The limitations of MRI/MRS, may lead to delayed treatment with antiviral agents, which can result in increased morbidity and mortality. The possibility of viral encephalitis should remain in the differential diagnosis of all patients presenting with headaches and confusion, even when imaging results are indicative of a neoplastic process.

Varicella-Zoster Virus: A Case of Encephalitis

Infection with the varicella-zoster virus (VZV) is very common worldwide and is one of the main causes of infectious encephalitis. Immunosuppressed patients are at increased risk of severe disease and central nervous system (CNS) involvement. We report the case of a 43-year-old man with HIV infection and poor adherence to antiretroviral therapy who presented to the emergency department (ER) with complaints of diplopia and a frontal headache, referring to having a child with chickenpox. Brain magnetic resonance imaging revealed three hyperintense T2-weighted lesions surrounded by edema in the right sublenticular, left occipital and left parietal regions, and VZV DNA was detected in the cerebrospinal fluid (CSF). After admitting the diagnosis of VZV encephalitis, the patient was treated with intravenous acyclovir, with clinical improvement and a favorable outcome.

Cerebrospinal fluid-based metabolomics to characterize different types of brain tumors

BACKGROUND

Brain tumors cause significant morbidity and mortality due to rapid progression and high recurrence risks. Reliable biomarkers to improve diagnosis thereof are desirable.

OBJECTIVE

This work aimed to identify panels of biomarkers for diagnostic purposes using cerebrospinal fluid (CSF)-based metabolomics.

METHODS

A cohort of 163 histologically-proven patients with brain disorders was involved. Comprehensive CSF-based metabolomics was achieved by liquid chromatography-quadrupole time-of-flight spectrometric (LC-Q/TOF-MS) and multivariate statistical analyses. The diagnostic performance of the metabolic markers was evaluated using receiver operating characteristic curves.

RESULTS

A total of 508 ion features were detected by the LC-Q/TOF-MS analysis, of which 27 metabolites were selected as diagnostic markers to discriminate different brain tumor types. The area under the curve (AUC) was 0.91 for lung adenocarcinoma patients with brain metastases (MBT) vs. lung adenocarcinoma patients without brain metastases (NMBT), 0.83 for primary central nervous system lymphoma (PCNSL) vs. secondary central nervous system involvement of systemic lymphoma (SCNSL), 0.77 for PCNSL vs. MBT, 0.87 for SCNSL vs. MBT, 0.86 for MBT vs. nontumorous brain diseases (NT), and 0.80 for PCNSL vs. NT. Perturbed metabolic pathways between the comparisons related mainly to amino acids and citrate metabolism.

CONCLUSIONS

CSF-based metabolomics to a large extent reliably identifies significant metabolic differences between different brain tumors and shows great potential for diagnosis of brain tumors.

Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients

Cerebral toxoplasmosis is a frequent complication in immunosuppressed patients such as AIDS (acquired immunodeficiency syndrome). Frequently, lesions are located deep in the brain which are inaccessible for biopsy making rapid diagnosis dependent on accurate interpretation of neuroimaging findings. The commonest cranial CT findings reported in toxoplasmosis are ring enhancing hypodense lesions in basal ganglia or cortical gray matter. Hemorrhage has only rarely been described and is usually seen following antitoxoplasma treatment. We reviewed the records of 11 AIDS patients with cerebral toxoplasmosis and found multiple hemorrhagic cerebral, cerebellar, or brain stem lesions in 7 of 11 patients. Six patients had hemorrhage at the time of initial clinical presentation and one developed hemorrhage following 2 weeks of antitoxoplasma treatment. We conclude that hemorrhagic lesions are frequently found on cranial MRI scans in cerebral toxoplasmosis. AIDS patients presenting with hemorrhagic cerebral lesions should be considered for a trial of presumptive antitoxoplasma treatment.

Varicella paediatric hospitalizations in Spain

Varicella is a very common childhood disease responsible for an important number of hospitalizations every year in Spain. The aim of this study was to assess the burden of chickenpox hospitalizations in Spain in the 7-year period between 1999 and 2005. Data of hospital discharges relating to varicella were obtained from the Conjunto Mínimo Básico de Datos (CMBD), the Spanish surveillance system for hospital data. All paediatric hospitalizations for primary varicella that occurred between 1 January 1999 and 31 December 2005 were selected. The hospitalization rate for the 7-year study period was 23·06 hospitalizations/100 000 population. The highest incidences of hospitalizations were observed in the youngest groups (60·79 and 55·65/100 000 population for ages 0–12 months and 1–2 years respectively). Nineteen deaths were reported during the study period. The median length of stay in hospital was 4 days (interquartile range 3–7 days). Despite the availability of effective varicella vaccines, chickenpox remains an important cause of hospitalizations in Spain.

Varicella encephalopathy in immunocompetent children

Two previously healthy girls presented acute encephalopathy due to varicella, with severe alteration of the conscious level and seizures. Both patients improved progressively after 15 days, with complete clinical recovery.

The pathogenesis and treatment of brain metastases: a comprehensive review

Brain metastases are the most common intracranial tumors and their incidence is increasing. Untreated brain metastases are associated with a poor prognosis and a poor performance status. The role of surgery in the management of multiple brain metastases is still controversial. As more than 70% of patients have multiple metastases at the time of diagnosis, whole brain radiotherapy is the treatment of choice in most cases. Brain metastases are an ideal target for stereotactic radiosurgery, as they are better circumscribed than primary brain tumors. Currently, chemotherapy has a limited role in the treatment of most brain metastases. Several new therapies, with a good penetration through the blood brain barrier, such as temozolomide, have been used in brain metastases with different results depending on the histology of the primary tumor. A better understanding of the complex processes underlying the development of brain metastasis will enable us to develop more satisfactory targeted treatments.

Brain metastases

Brain metastases are one of the most feared complications of cancer because even small tumors may cause incapacitating neurologic symptoms. This article reviews the epidemiology, clinical features, treatment, and prognosis of brain metastases from system malignancies.

Zoster in patients infected with HIV: a review

Varicella-zoster virus (VZV), a member of the human herpesvirus family, causes childhood chickenpox (varicella), becomes latent in sensory ganglia, and reactivates years later in immunocompromised and elderly persons to produce shingles (herpes zoster). Early in the AIDS epidemic, zoster was noted in adults and children infected with HIV. Severe and debilitating zoster-associated dermatological, ophthalmic, and neurological complications may occur in patients infected with HIV. Antiviral therapy can modify the duration of zoster and alleviate its attendant complications. Varicella vaccine may boost the immunity and prevent virus reactivation. VZV immune globulin (VZIG) prevents or modifies clinical illness in persons who have been exposed to varicella or zoster.

Acute neurologic complications in children with systemic cancer

Neurologic complications are common in children with cancer, but the literature dealing with this subject is sparse. Using a symptoms and signs approach, the most common causes for requesting a neurologic evaluation for this population are reviewed. The spectrum of neurologic symptoms in children with cancer differs from adults and requires the consulting neurologist to have a thorough knowledge of childhood cancer and its effects on the nervous system.

The Diagnosis and Management of Syphilis in the HIV-Infected Patient

In the 1980s, the number of cases of syphilis in the United States increased concurrently with the onset of the HIV epidemic. Within a short time, clinicians began to note unusual presentations of syphilis and inappropriate responses to standard therapy for syphilis in dually infected patients. Whether these cases collectively represented a new aspect of the natural history of syphilis remains to be elucidated. In recent years, only a few prospective studies have addressed this issue, and the results of these studies have been inconclusive.

Encephalitis

Encephalitis is an acute infection of brain parenchyma characterized clinically by fever, headache, and an altered level of consciousness. There may also be focal or multifocal neurologic deficits, and focal or generalized seizure activity. This article discusses the clinical presentation, diagnosis, and treatment of herpes simplex virus (HSV) encephalitis, the arthropodborne viral encephalidities, Rocky Mountain spotted fever, viral encephalitis in the immunocompromised patient, and postinfectious encephalomyelitis.