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Yum KS, Shin DI. Transient splenial lesions of the corpus callosum and infectious diseases. Acute Crit Care 2022; 37:269-275. [PMID: 35977887 PMCID: PMC9475166 DOI: 10.4266/acc.2022.00864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022] Open
Abstract
Transient splenial lesion of the corpus callosum can be observed in various diseases such as cancer, drug use, metabolic disorders, and cerebrovascular disorders, as well as in patients with infectious diseases. During the coronavirus disease 2019 (COVID-19) pandemic, there were increasing reports of these lesions being detected on brain imaging tests performed in patients with neurological symptoms. On brain magnetic resonance imaging, findings suggestive of cytotoxic edema are observed in the splenium; these are known to disappear with improvement of clinical symptoms. Cytokinopathy caused by infection increases the permeability of the blood–brain barrier and activates the glial cells of the brain to induce cytotoxic edema. Most patients have a good prognosis. The causes, mechanism, diagnosis, treatment and prognosis of transient splenial lesions of the corpus callosum will be summarized in this review.
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Ku MC, Suh SI, Lee HJ, Ryoo IS, Son GR, Lee YH, Seo HS, Seol HY. Hemorrhagic fever with renal syndrome-related encephalopathy: magnetic resonance imaging findings. Clin Imaging 2015; 39:975-8. [PMID: 26362353 DOI: 10.1016/j.clinimag.2015.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/28/2015] [Accepted: 08/12/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report the incidence and findings of brain magnetic resonance imaging (MRI) in patients with hemorrhagic fever with renal syndrome (HFRS)-related encephalopathy along with its clinical course. METHODS Medical records and brain MRI were reviewed from January 2004 to January 2013. The final cohort consisted of 145 patients. Brain MRI findings were correlated with associated clinical stage of disease. RESULTS The MRI findings associated with clinical course of HFRS-related encephalopathy were posterior reversible encephalopathy syndrome pattern (n=3) in oliguric phase and splenial lesion pattern (n=1) in febrile phase. CONCLUSIONS Brain MRI findings in HFRS-related encephalopathy may be associated with the clinical course of HFRS.
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Affiliation(s)
- Min-Cheol Ku
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang-il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Hyun-Ji Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - In-Seon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Gyu-Ri Son
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyeong Suk Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hae-Young Seol
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Harini C, Das RR, Prabhu SP, Singh K, Haldar A, Takeoka M, Bergin AM, Loddenkemper T, Kothare SV. Clinical and Neuroimaging Profile of Children with Lesions in the Corpus Callosum. J Neuroimaging 2014; 25:824-31. [PMID: 25523474 DOI: 10.1111/jon.12190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 07/23/2014] [Accepted: 09/13/2014] [Indexed: 12/14/2022] Open
Abstract
PURPOSE T2-hyperintense signal changes in corpus callosum (CC) have been described in epilepsy and encephalitis/encephalopathy. Little is known about their pathophysiology. The aim of this study was to examine the clinical presentation and evolution of CC lesions and relationship to seizures. METHODS We identified 12 children among 29,634 patients from Radiology Database. We evaluated following characteristics: seizures and accompanying medical history, antiepileptic drug usage, presenting symptoms, and radiological evolution of lesions. RESULTS CC lesions were seen in patients with prior diagnosis of epilepsy (n = 5) or in those with new onset seizures (n = 3), or with encephalitis/encephalopathy without history of seizures (n = 4). Seizure clustering or disturbances of consciousness were the main presenting symptoms. No relationship was observed between CC lesion and AEDs. On imaging, ovoid lesions at presentation resolved on follow up imaging and linear lesions persisted. DTI showed that the fibers passing through splenial lesions originated from the posterior parietal cortex and occipital cortex bilaterally. CONCLUSION In patients with seizures, no clear relationship was demonstrated between seizure characteristics or AED use with CC lesions. Ovoid lesions resolved and may have different pathophysiologic mechanism when compared to linear lesions that persisted.
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Affiliation(s)
- Chellamani Harini
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Rohit R Das
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Department of Neurology, Indiana State University, Indianapolis, IN
| | - Sanjay P Prabhu
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Harvard Medical School, Boston, MA
| | - Kanwaljit Singh
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Lurie Center, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | - Amit Haldar
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Masanori Takeoka
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ann M Bergin
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tobias Loddenkemper
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Sanjeev V Kothare
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,New York University Medical Center, Comprehensive Epilepsy Center, Langone Medical School, NY
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Shin OS, Song GS, Kumar M, Yanagihara R, Lee HW, Song JW. Hantaviruses induce antiviral and pro-inflammatory innate immune responses in astrocytic cells and the brain. Viral Immunol 2014; 27:256-66. [PMID: 24937036 DOI: 10.1089/vim.2014.0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although hantaviruses are not generally considered neurotropic, neurological complications have been reported occasionally in patients with hemorrhagic fever renal syndrome (HFRS). In this study, we analyzed innate immune responses to hantavirus infection in vitro in human astrocytic cells (A172) and in vivo in suckling ICR mice. Infection of A172 cells with pathogenic Hantaan virus (HTNV) or a novel shrew-borne hantavirus, known as Imjin virus (MJNV), induced activation of antiviral genes and pro-inflammatory cytokines/chemokines. MicroRNA expression profiles of HTNV- and MJNV-infected A172 cells showed distinct changes in a set of miRNAs. Following intraperitoneal inoculation with HTNV or MJNV, suckling ICR mice developed rapidly progressive, fatal central nervous system-associated disease. Immunohistochemical staining of virus-infected mouse brains confirmed the detection of viral antigens within astrocytes. Taken together, these findings suggest that the neurological findings in HFRS patients may be associated with hantavirus-directed modulation of innate immune responses in the brain.
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Affiliation(s)
- Ok Sarah Shin
- 1 Department of Biomedical Sciences, College of Medicine, Korea University , Gurodong, Gurogu, Seoul, Republic of Korea
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Robbins NM, Kumar A, Blair BM. Legionella pneumophila infection presenting as headache, confusion and dysarthria in a human immunodeficiency virus-1 (HIV-1) positive patient: case report. BMC Infect Dis 2012; 12:225. [PMID: 22998348 PMCID: PMC3519780 DOI: 10.1186/1471-2334-12-225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/20/2012] [Indexed: 11/24/2022] Open
Abstract
Background Legionella pneumophila is a common cause of community-acquired pneumonia. Central nervous system dysfunction is common, and diagnosis in the absence of pulmonary symptoms can be challenging. Here we describe an atypical clinical presentation of Legionella infection in a patient with HIV who was found to have an unusual neuroradiologic lesion that further served to obscure the diagnosis. This is the first such description in a patient with Legionellosis and HIV coinfection. Case presentation A 43 year-old HIV positive man presented to our hospital with dysarthria, fevers, headache, and altered mental status. Initial work-up revealed pneumonia and a lesion of the splenium of the corpus callosum on magnetic resonance imaging. He was subsequently diagnosed with Legionella pneumonia and treated with complete symptom resolution. Conclusions Neurologic abnormalities are frequent in Legionellosis, but the diagnosis may be difficult in the absence of overt respiratory symptoms and in the presence of HIV coinfection. A high index of suspicion and early initiation of empiric antibiotics is imperative since early treatment may help prevent long-term sequelae. Neuroimaging abnormalities, though rare, can help the physician narrow down the diagnosis and avoid unnecessary invasive testing. Future studies should aim to elucidate the as yet unknown role of neuroimaging in the diagnoses and prognostication of Legionellosis, as well as the interaction between Legionella infection and HIV.
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Affiliation(s)
- Nathaniel M Robbins
- Department of Neurology, University of California, 505 Parnassus Ave, M-798, San Francisco, CA 94137, USA.
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Sargianou M, Watson DC, Chra P, Papa A, Starakis I, Gogos C, Panos G. Hantavirus infections for the clinician: From case presentation to diagnosis and treatment. Crit Rev Microbiol 2012; 38:317-29. [DOI: 10.3109/1040841x.2012.673553] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Stingl K, Bruckmann A. [Acute myopia]. Ophthalmologe 2011; 108:859-62. [PMID: 21688053 DOI: 10.1007/s00347-011-2385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper presents a case of ocular involvement during acute renal failure caused by hantavirus. A 34-year-old man suffered from sudden visual loss during acute onset fever with nausea and renal failure. The ophthalmologic examination showed myopia in both eyes and no signs of infection but virological studies revealed an infection with hantavirus. During treatment of the renal failure the myopia improved spontaneously. Transient myopia is a typical ocular involvement during infections with hantavirus which leads to renal failure.
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Affiliation(s)
- K Stingl
- Department und Forschungsinstitut für Augenheilkunde, Universitätsklinikum Tübingen, Schleichstr. 12-16, 72076, Tübingen, Deutschland.
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