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Kant Misra U, Kalita J, Singh Chauhan P. Evaluation of cholinergic functions in patients with Japanese encephalitis and Herpes simplex encephalitis. Brain Res 2018; 1707:227-232. [PMID: 30468725 DOI: 10.1016/j.brainres.2018.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 12/23/2022]
Abstract
Cognitive and memory impairment are related to cholinergic dysfunction and are important complications of viral encephalitis, In view of paucity of studies on cholinergic dysfunction in encephalitis, this study has been undertaken. We report acetyl choline esterase (AChE) and muscurinic 2 (M2) receptor levels in herpes simplex encephalitis (HSE) and Japanese encephalitis (JE) patients, and correlate these with cognitive functions and MRI findings. Patients with JE and HSE were evaluated for consciousness, neurological and MRI findings, plasma AChE and M2 receptor levels on admission and after one year. Twenty-nine patients with JE and 23 with HSE were included. Admission AChE levels in JE (48.32 ± 5.36 nmol/min/ml) and HSE (41.92 ± 5.12 nmol/min/ml) were significantly lower compared with controls (70.50 ± 8.30 nmol/min/ml). M2 receptor levels were also low in JE (4.52 ± 0.56 ng/ml) and HSE (4.35 ± 0.57 ng/ml) compared with controls (7.95 ± 0.41 ng/ml). In JE, AChE activity (r = 0.43, p = 0.02) and M2 receptor levels (r = 0.43, p = 0.02) correlated with caudate involvement, and AChE activity (r = 0.76, p = 0.03) with Mini Mental State Examination ( MMSE) score. In HSE, M2 receptor levels (r = 0.53, p = 0.03) correlated with MMSE. The levels of AChE and M2 receptors increased at one year compared to the baseline, which was greater in JE than in HSE. Both AChE and M2 receptors were reduced in JE and HSE and correlated with cognition at one year. Recovery of these biomarkers was more in JE than HSE.
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Affiliation(s)
- Usha Kant Misra
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Prashant Singh Chauhan
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Cooper J, Kierans C, Defres S, Easton A, Kneen R, Solomon T. Care beyond the hospital ward: understanding the socio-medical trajectory of herpes simplex virus encephalitis. BMC Health Serv Res 2017; 17:646. [PMID: 28899392 PMCID: PMC5596960 DOI: 10.1186/s12913-017-2608-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus (HSV) encephalitis is a life-threatening infection of the brain, which has significant physical, cognitive and social consequences for survivors. Despite increasing recognition of the long-term effects of encephalitis, research and policy remains largely focused on its acute management, meaning there is little understanding of the difficulties people face after discharge from acute care. This paper aims to chart the problems and challenges which people encounter when they return home after treatment for HSV encephalitis. METHODS The paper reports on data from 30 narrative interviews with 45 people affected by HSV encephalitis and their significant others. The study was conducted as part of the ENCEPH-UK programme grant on Understanding and Improving the Outcome of Encephalitis. RESULTS The findings show the diverse challenges which are experienced by people after treatment for HSV encephalitis. We first chart how peoples' everyday lives are fragmented following their discharge from hospital. Second, we document the social consequences which result from the longer-term effects of encephalitis. Finally, we show how the above struggles are exacerbated by the lack of support systems for the post-acute effects of encephalitis, and describe how people are consequently forced to devise their own care routines and strategies for managing their problems. CONCLUSION The paper argues that in order to improve long-term outcomes in encephalitis, it is vital that we develop pathways of support for the condition beyond the acute hospital setting. We conclude by making recommendations to enhance communication and care for the post-acute consequences of encephalitis, to ensure those affected are fully supported through the chronic effects of this devastating disease.
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Affiliation(s)
- Jessie Cooper
- Division of Health Services Research & Management, City, University of London, London, UK
| | - Ciara Kierans
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sylviane Defres
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Tropical and infectious diseases Unit, The Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
- NIHR HPRU in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Ava Easton
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- The Encephalitis Society, Malton, North Yorkshire, UK
| | - Rachel Kneen
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Tom Solomon
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- NIHR HPRU in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Goren A, Mccoy J, Kovacevic M, Situm M, Lonky N. Potential risk of developing herpes simplex encephalitis in patients treated with sildenafil following primary exposure to genital herpes. J BIOL REG HOMEOS AG 2017; 31:679-682. [PMID: 28956417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Herpes simplex encephalitis (HSE) is associated with significant mortality and morbidity. As a consequence of HSE, up to 75% of infected individuals die or experience irreversible neurological damage. While the pathogenesis of the disease is unknown, it is traditionally hypothesized that the viral infection occurs by neuronal transmission directly from peripheral sites. Non-neuronal modes of infection have generally been overlooked as the brain is protected by the blood-brain-barrier (BBB). The BBB poses an effective barrier to pathogens as well as to drugs such as chemotherapies. In the pursuit to deliver chemotherapeutic agents to the brain, several studies demonstrated that phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, may increase the permeability of the BBB enabling successful delivery of chemotherapeutic agents to the brain. In this communication, we report a case of HSE infection in a 62-year-old man, which we suspect was facilitated by the use of sildenafil during a primary genital herpes simple virus (HSV) infection. Due to large number of patients treated with PDE5 inhibitors for erectile dysfunction and the high incidence of genital HSV infection in the general population, a larger study should examine the potential risk of developing HSE in patients treated with PDE5 inhibitors.
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Affiliation(s)
- A Goren
- Applied Biology, Inc., Irvine, California, USA
- Department of Dermatology and Venereology, University of Rome “G. Marconi”, Rome, Italy
| | - J Mccoy
- Applied Biology, Inc., Irvine, California, USA
| | - M Kovacevic
- Department of Dermatology and Venereology, University of Rome “G. Marconi”, Rome, Italy
| | - M Situm
- Department of Dermatology and Venereology, University Hospital Center “Sestre milosrdnice”, Zagreb, Croatia
| | - N Lonky
- University of California, School of Medicine, Irvine, California, USA
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Defres S, Keller SS, Das K, Vidyasagar R, Parkes LM, Burnside G, Griffiths M, Kopelman M, Roberts N, Solomon T. A Feasibility Study of Quantifying Longitudinal Brain Changes in Herpes Simplex Virus (HSV) Encephalitis Using Magnetic Resonance Imaging (MRI) and Stereology. PLoS One 2017; 12:e0170215. [PMID: 28125598 PMCID: PMC5268482 DOI: 10.1371/journal.pone.0170215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/02/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy. METHODS The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting. RESULTS Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids. CONCLUSIONS This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis.
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Affiliation(s)
- Sylviane Defres
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious diseases Unit, Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom
- NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Institute of infection and Global Health, Waterhouse Building, Liverpool, United Kingdom
| | - Simon S. Keller
- The Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Kumar Das
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Rishma Vidyasagar
- Florey Institute of Neuroscience and mental health, Heidelberg, Victoria, Australia
- Department of Anatomy and Neuroscience, University of Melbourne, Victoria, Australia
| | - Laura M. Parkes
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Girvan Burnside
- The department of Biostatistics, Institute of translational medicine, University of Liverpool, Liverpool, United Kingdom
| | - Michael Griffiths
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Michael Kopelman
- Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Neil Roberts
- Medical Physics and Imaging Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tom Solomon
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Institute of infection and Global Health, Waterhouse Building, Liverpool, United Kingdom
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
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Affiliation(s)
- Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of General Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen-Yi Chiu
- Department of Family Medicine, Zouying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC.
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC.
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Te-Yu Lin
- Department of General Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
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Croll BJ, Dillon ZM, Weaver KR, Greenberg MR. Subtle presentation of herpes simplex encephalitis. Am J Emerg Med 2016; 35:200.e1-200.e2. [PMID: 27510472 DOI: 10.1016/j.ajem.2016.07.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 07/23/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Benjamin J Croll
- Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, CC & I-78, Allentown, PA 18103.
| | - Zachary M Dillon
- Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, CC & I-78, Allentown, PA 18103
| | - Kevin R Weaver
- Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, CC & I-78, Allentown, PA 18103
| | - Marna Rayl Greenberg
- Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, CC & I-78, Allentown, PA 18103
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Abstract
Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be life-saving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.
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Affiliation(s)
- Michael J Bradshaw
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arun Venkatesan
- Division of Neuroimmunology & Neuroinfectious Diseases, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Pistacchi M, Marsala SZ, Gioulis M, Sanson F, Giometto B. Uncommon relapse after post-herpes simplex encephalitis: an atypical case report. Acta Neurol Belg 2015; 115:691-5. [PMID: 25894351 DOI: 10.1007/s13760-015-0475-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Michele Pistacchi
- Neurology Service, Santorso Hospital, Via Garziere 73, 36014, Santorso, Italy.
| | | | - Manuela Gioulis
- Neurology Service, San Martino Hospital, Belluno, Viale Europa 22, Belluno, Italy
| | - Flavio Sanson
- Neurology Service, Santorso Hospital, Via Garziere 73, 36014, Santorso, Italy
| | - Bruno Giometto
- Clinica Neurologica 2^, Azienda ULSS16 Padova, Padua, Italy
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Veciana M, Becerra JL, Fossas P, Muriana D, Sansa G, Santamarina E, Gaig C, Carreño M, Molins A, Escofet C, Ley M, Vivanco R, Pedro J, Miró J, Falip M. EEG extreme delta brush: An ictal pattern in patients with anti-NMDA receptor encephalitis. Epilepsy Behav 2015; 49:280-5. [PMID: 26071995 DOI: 10.1016/j.yebeh.2015.04.032] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/17/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The anti-NMDA receptor (NMDAr) encephalitis-associated syndrome includes neuropsychiatric symptoms, impaired consciousness, seizures, autonomic instability, and hypoventilation. The electroencephalographic (EEG) activity throughout the course of the disease has still not been well documented. We reviewed electroclinical data of patients with NMDAr encephalitis to characterize their EEG and its clinical correlation. MATERIAL AND METHODS We retrospectively identified 16 patients with NMDAr encephalitis from 8 Spanish medical centers, 15 of whom underwent video-EEG in the acute phase. RESULTS In 15 patients (11 females, median age: 37.4, range: 14-87 years), seizures occurred in 9 (60%) and status epilepticus (SE) in 5 (33.3%). Magnetic resonance imaging (MRI) was abnormal in 10 (66.6%), and CSF (cerebrospinal fluid) was normal in 3 and abnormal in 12, with positive PCR (polymerase chain reaction) for Mycoplasma pneumoniae (1/15) and herpes simple virus (1/15). An ovarian teratoma was found in 1 patient and other malignancies (small cell lung carcinoma) in 1 patient. The EEG was abnormal in the acute phase in 14/15 (93.3%). Extreme delta brush (EDB) was observed in 5 (33.3%), and the presence of EDB was associated with SE in all cases. Rhythmic delta activity without EDB was observed in 5 (33.3%), while excessive beta activity was present in 4 (26.6%). Extreme delta brush can follow a pattern of well-characterized electroclinical seizures. CONCLUSIONS Almost invariably, patients with NMDAr encephalitis had abnormal EEG. The presence of EDB, which can follow a pattern of well-characterized electroclinical seizures, in our patients was associated with seizures and SE. These findings suggest that EDB could be an evolutive pattern of an SE in NMDAr encephalitis. This article is part of a Special Issue entitled "Status Epilepticus".
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Affiliation(s)
- M Veciana
- Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - J L Becerra
- Servei de Neurologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | - P Fossas
- Servei de Neurologia, Hospital de Mataró, Spain
| | - D Muriana
- Servei de Neurologia, Hospital de Mataró, Spain
| | - G Sansa
- Servei de Neurologia, Hospital Parc Taulí, Sabadell, Spain
| | - E Santamarina
- Servei de Neurologia, Hospital Vall d´Hebrón, Barcelona, Spain
| | - C Gaig
- Servei de Neurologia, Hospital Clínic i Provincial, Barcelona, Spain
| | - M Carreño
- Servei de Neurologia, Hospital Clínic i Provincial, Barcelona, Spain
| | - A Molins
- Servei de Neurologia, Hospital Universitari Josep Trueta, Girona, Spain
| | - C Escofet
- Servei de Neurologia, Hospital Parc Taulí, Sabadell, Spain
| | - M Ley
- Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | - R Vivanco
- Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | - J Pedro
- Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - J Miró
- Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - M Falip
- Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
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Wilcox DR, Wadhwani NR, Longnecker R, Muller WJ. Differential reliance on autophagy for protection from HSV encephalitis between newborns and adults. PLoS Pathog 2015; 11:e1004580. [PMID: 25569138 PMCID: PMC4287605 DOI: 10.1371/journal.ppat.1004580] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/16/2014] [Indexed: 12/18/2022] Open
Abstract
Newborns are more susceptible to severe disease from infection than adults, with maturation of immune responses implicated as a major factor. The type I interferon response delays mortality and limits viral replication in adult mice in a model of herpes simplex virus (HSV) encephalitis. We found that intact type I interferon signaling did not control HSV disease in the neonatal brain. However, the multifunctional HSV protein γ34.5 involved in countering type I interferon responses was important for virulence in the brain in both age groups. To investigate this observation further, we studied a specific function of γ34.5 which contributes to HSV pathogenesis in the adult brain, inhibition of the cellular process of autophagy. Surprisingly, we found that the beclin binding domain of γ34.5 responsible for inhibiting autophagy was dispensable for HSV disease in the neonatal brain, as infection of newborns with the deletion mutant decreased time to mortality compared to the rescue virus. Additionally, a functional beclin binding domain in HSV γ34.5 did not effectively inhibit autophagy in the neonate, unlike in the adult. Type I IFN responses promote autophagy in adult, a finding we confirmed in the adult brain after HSV infection; however, in the newborn brain we observed that autophagy was activated through a type I IFN-independent mechanism. Furthermore, autophagy in the wild-type neonatal mouse was associated with increased apoptosis in infected regions of the brain. Observations in the mouse model were consistent with those in a human case of neonatal HSV encephalitis. Our findings reveal age-dependent differences in autophagy for protection from HSV encephalitis, indicating developmental differences in induction and regulation of this innate defense mechanism after HSV infection in the neonatal brain. Disease after infection with a pathogen results from an intersection between the infectious agent and the host. Newborns are particularly susceptible to infectious illness compared to adults, and HSV infection commonly results in devastating encephalitis. We studied the interaction of HSV with the type I interferon pathway and found that a specific activity of the viral protein γ34.5, which counters host autophagy to promote encephalitis in adults, was not required to cause disease in newborns. Furthermore, autophagy was not inhibited by HSV in the neonate and was not activated by type I interferon signaling, unlike in the adult. Activated autophagy was associated with increased apoptosis, which may contribute to the increased pathology in newborns. Our findings reveal development-specific differences in the pathogenesis of HSV encephalitis, including a distinct role for autophagy in the neonatal brain.
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Affiliation(s)
- Douglas R. Wilcox
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Nitin R. Wadhwani
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States of America
| | - Richard Longnecker
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - William J. Muller
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
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Ikeda R, Nishihara R, Taniguchi K, Morita M, Fujii T, Utsunomiya K, Tajima N, Yamada H, Takahashi Y. [Case report; a 28-year-old woman with non-herpetic limbic encephalitis presenting behavioral abnormality, restlessness, and abnormal movement of legs]. Nihon Naika Gakkai Zasshi 2011; 100:487-490. [PMID: 21400888 DOI: 10.2169/naika.100.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Rina Ikeda
- Department of Internel Medicine, Fuji City General Hospital, Japan
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Dekonenko EP, Rudometov IP, Kupriianova LV. [Analysis of clinical features of herpes encephalitis]. Zh Nevrol Psikhiatr Im S S Korsakova 2011; 111:18-24. [PMID: 21423111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Herpes encephalitis makes up more than 20% of all viral encephalitises in countries with moderate climate. Over the period of 1971-2008, 112 inpatients with herpes encephalitis have been examined and treated. Outcomes were as follows: 90 (80%) patients recovered and 22 (20%) patients died. The diagnostic criteria were the relation with herpes simplex virus type I (HSV-1) by immunological and clinical data in the presence of clinical symptoms of viral encephalitis for recovered patients and clinical symptoms of acute encephalitis, morphological foci of necrosis in the brain, relation with HSV, the absence of other alternative diagnosis for dead patients. Based on the analysis of 112 patients, the authors present clinical symptoms of herpes encephalitis. The presentation is supported by 2 case reports.
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Roche JC, Roche JR, Martín J. [Oligodendroglioma simulating acute herpetic encephalitis]. Neurologia 2009; 24:433-434. [PMID: 20050115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Kalita J, Misra UK, Srivastava A. Cognitive impairment in encephalitis: P3 and MRI correlation. Electromyogr Clin Neurophysiol 2009; 49:27-33. [PMID: 19280797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE In view of paucity of studies on P3 in encephalitis, we report clinical, MRI and P3 changes in encephalitis patients. DESIGN The diagnosis of encephalitis was based on clinical, MRI, ELISA and/or PCR and categorized into Japanese encephalitis (JE), dengue, herpes (HSE) and nonspecific group. Cognitive functions were evaluated 1 month after the illness when patient was able to cooperate for Mini Mental State examination (MMSE). P3 was carried out by odd ball auditory paradigm recording from Cz, Fz and Pz referred to linked mastoids. RESULTS 30 encephalitis patients including 16 JE, 2 HSE and 12 nonspecific whose median age was 24 (13-53) years were prospectively evaluated. P3 was studied after a median duration of 3 months. MMSE was abnormal in 19 patients. CzP3 was abnormal in 6; 5 of whom had abnormal MMSE. MRI was abnormal in 18 showing thalamic lesion in 13, basal ganglia in 3 and cortical in 7 patients. MMSE was abnormal in all the patients with HSE, 81% with JE and 33% with nonspecific encephalitis. P3 was more frequently abnormal in patients with abnormal MMSE and MRI. CONCLUSION Cognitive impairment is common in HSE and JE; abnormal MMSE and MRI are associated with P3 abnormality.
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MESH Headings
- Adolescent
- Adult
- Cognition Disorders/etiology
- Cognition Disorders/pathology
- Cognition Disorders/physiopathology
- Dengue/complications
- Dengue/pathology
- Dengue/physiopathology
- Encephalitis, Herpes Simplex/complications
- Encephalitis, Herpes Simplex/pathology
- Encephalitis, Herpes Simplex/physiopathology
- Encephalitis, Japanese/complications
- Encephalitis, Japanese/pathology
- Encephalitis, Japanese/physiopathology
- Encephalitis, Viral/complications
- Encephalitis, Viral/pathology
- Encephalitis, Viral/physiopathology
- Event-Related Potentials, P300
- Female
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Psychiatric Status Rating Scales
- Young Adult
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Affiliation(s)
- J Kalita
- Department of Neurology, Sanjay Gandhi PGIMS, Lucknow, India.
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Abstract
OBJECTIVE Herpes simplex virus encephalitis (HSVE) patients occasionally follow a prolonged course despite standard antiviral treatment. The purpose of this study was to analyze clinical variables to identify predictors of a prolonged course. METHODS A series of 23 HSVE patients treated with acyclovir (ACV) during the acute stage were selected and divided into 2 groups: the non-prolonged group (n = 15), with improvement within 2 weeks after initial ACV treatment; and the prolonged group (n = 8), without improvement within 2 weeks. Differences in clinical variables, including age, duration from onset to initial ACV treatment, Glasgow coma scale (GCS) score, corticosteroid administration, detection of abnormal lesions on initial cranial computed tomography (CT) and magnetic resonance imaging, detection of periodic lateralized epileptiform discharges on electroencephalogram, and clinical outcome, were compared between the groups. RESULTS There were significant differences in GCS score, clinical outcome, and detection of lesions on CT between the non-prolonged and prolonged groups [p = 0.021, p = 0.041 (Mann-Whitney's U test), respectively, and p = 0.027 (Fisher's exact test)]. Four of the eight patients with a prolonged course had a poor outcome despite treatment with additional drugs. CONCLUSION A lower GCS and a higher rate of lesions on CT were identified as predictors of a prolonged course for HSVE. These predictors are in accordance with the conventional predictors of poor outcome for HSVE. This study suggests that the initial ACV treatment was insufficient for HSVE patients with these predictors at the acute stage. The initial treatment may need to be modified for such patients.
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Affiliation(s)
- Naoto Taira
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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17
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Bayram N, Ciftdogan DY, Karapinar B, Ozgiray E, Polat M, Cagliyan E, Vardar F. A case of herpes simplex encephalitis revealed by decompressive craniectomy. Eur J Pediatr 2008; 167:821-2. [PMID: 17912551 DOI: 10.1007/s00431-007-0566-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 06/28/2007] [Indexed: 11/26/2022]
Abstract
A 15-year-old girl was referred to our hospital due to fever, headache, and vomiting of 7 days duration and focal motor convulsion at the day of referral. Her clinical signs and cerebral imaging findings were found to be compatible with herpes simplex encephalitis. In spite of prompt acyclovir administration, her consciousness deteriorated gradually. Emergent cranial magnetic resonance imaging demonstrated a shift of midline intracranial structures. Decompressive surgery resulted in partial improvement in the shift of midline intracranial structures and potentially saved the patient's life. This case report stresses the importance of proper management of increased intracranial pressure in patients with herpes simplex encephalitis.
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Affiliation(s)
- N Bayram
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
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18
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Devrim I, Tezer H, Haliloğlu G, Kara A, Seçmeer G. Relapsing Herpes simplex virus encephalitis despite high-dose acyclovir therapy: a case report. Turk J Pediatr 2008; 50:380-382. [PMID: 19014054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Central nervous system infection of Herpes simplex virus (HSV) is the most common etiologic agent of the non-epidemic fatal form of encephalitis. Relapse of HSV encephalitis is rare in childhood. In this report, we present our experience in a 36-month-old child with relapse of HSV encephalitis after 14-day acyclovir therapy. A 36-month-old boy who was presented with deterioration in speech and motor functions and fluctuation of consciousness was treated with acyclovir for 14 days for HSV encephalitis. He was discharged since his cerebrospinal fluid findings returned to normal range and clinical improvement was seen. Ten days later, he was readmitted to our clinic with acute fever, focal convulsions and choreoathetoid movements, and altered consciousness. Acyclovir was started immediately, but he died on the 17th day because of respiratory failure. Relapses due to HSV encephalitis are rare and limited to a small number of case reports in the literature. Persistence of HSV, detection of high viral load or detection of HSV by polymerase chain reaction, prior corticosteroid therapy, low total dosage of acyclovir (especially for children under 2 years of age) and short duration of therapy were suspected risk factors. Even absence of pleocytosis and normal cerebrospinal fluid biochemistry in our patient after treatment did not indicate eradication of HSV. In our opinion, treatment duration of HSV encephalitis, especially in small children, must be at least 21 days. Clinical and experimental studies are required since only case reports on this topic exist.
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Affiliation(s)
- Ilker Devrim
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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19
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De Tiège X, Rozenberg F, Héron B. The spectrum of herpes simplex encephalitis in children. Eur J Paediatr Neurol 2008; 12:72-81. [PMID: 17870623 DOI: 10.1016/j.ejpn.2007.07.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 07/05/2007] [Accepted: 07/10/2007] [Indexed: 11/19/2022]
Abstract
Clinical and basic science research carried out in recent years into herpes simplex encephalitis (HSE) have shown that the concept of a "classical" picture of HSE in children is now outdated and that our current knowledge of the disease is probably only the tip of an iceberg. Indeed, increasing evidence supports the existence of a wider range of pathophysiological mechanisms, clinical presentations and disease progressions in paediatric HSE. This paper reviews the clinical, biological and radiological data available and redefines the spectrum of HSE in children. Full understanding of the condition should improve the management of suspected cases and decrease the morbidity and the mortality associated with this disease.
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Affiliation(s)
- Xavier De Tiège
- Department of Paediatric Neurology, ULB-Hôpital Erasme, Brussels, Belgium.
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20
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Valtonen J, Dilks DD, McCloskey M. Cognitive representation of orientation: a case study. Cortex 2007; 44:1171-87. [PMID: 18761131 DOI: 10.1016/j.cortex.2007.06.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 04/10/2007] [Accepted: 06/14/2007] [Indexed: 11/19/2022]
Abstract
Although object orientation in the human brain has been discussed extensively in the literature, the nature of the underlying cognitive representation(s) remains uncertain. We investigated orientation perception in BC, a patient with bilateral occipital and parietal damage from a herpes encephalitis infection. Our results show that in addition to general inaccuracy in discriminating and reproducing line orientations, her errors take the form of left-right mirror reflections across a vertical coordinate axis. We propose that in BC, the cognitive impairment is in failing to represent the direction of tilt for line orientations. Our results suggest that there exists a level of representation in the human brain at which line orientations are represented compositionally, such that the direction of a line orientation's tilt from a vertical mental reference meridian is coded independently of the magnitude of its angular displacement. Reflection errors across a vertical axis were observed both in visual and tactile line orientation tasks, demonstrating that these errors arise at a supra-modal level of representation not restricted to vision, or, alternatively, that visual-like representations are being constructed from the tactile input.
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Affiliation(s)
- Jussi Valtonen
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States.
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21
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Abstract
The cognitive sequelae of encephalitis are well documented, and it is increasingly recognised that disorders of mood and anxiety can accompany these sequelae. Loss of identity is emerging as a key theme in psychotherapeutic interventions in adjustment following acquired brain injury (ABI). Cognitive-behavioural therapy can be applied to construct a new model of the self in the context of behavioural, cognitive and social sequelae of the ABI, with consideration of pre-illness identity. Behavioural experiments, in particular, may be an effective means of redefining the meaning of current situations to create a positive sense of self. In the current paper we describe the therapeutic intervention to address anxiety and changes in identity in a woman recovering from herpes simplex viral encephalitis. The intervention highlights the need to take into account the interplay between cognitive changes, such as memory and executive function, with emotion in adjustment following herpes simplex viral encephalitis.
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22
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Lundberg P, Openshaw H, Wang M, Yang HJ, Cantin E. Effects of CXCR3 Signaling on Development of Fatal Encephalitis and Corneal and Periocular Skin Disease in HSV-Infected Mice Are Mouse-Strain Dependent. ACTA ACUST UNITED AC 2007; 48:4162-70. [PMID: 17724202 DOI: 10.1167/iovs.07-0261] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The host inflammatory response to ocular infection with herpes simplex virus (HSV) can be either protective, with disease-free survival, or it can promote diseases such as HSV corneal disease (or herpes stromal keratitis [HSK] in humans) and encephalitis (HSE), depending on mouse strain. The role of CXCR3 chemokine signaling in HSV-induced central nervous system (CNS) inflammation and corneal disease was evaluated, and responses in genetically susceptible and resistant strains of mice were contrasted. METHODS Resistant C57BL/6J (B6) and susceptible 129S6 (129) mice were given monoclonal antibodies (mAbs) to neutralize the CXCR3 ligands monokine induced by interferon-gamma (MIG, CXCL9) and interferon inducible protein-10 (IP-10, CXCL10) during HSV infection. In addition, the development of HSV disease was monitored in CXCR3-null mutant mice derived from resistant (B6) and susceptible (BALB/c) strains. Inflammatory cells infiltrating the cornea and brain stem were isolated and stained for flow cytometric analysis. RESULTS MIG and IP-10 were induced in nervous system tissue after HSV inoculation by the corneal route. HSV-infected 129 mice treated with MIG- or IP-10-neutralizing mAbs showed significantly enhanced survival compared with mice treated with control isotype antibody, whereas survival of the B6 mice was unaltered. Similarly, greater survival was observed for BALB.CXCR3(-/-) mice compared with control BALB/c mice. Reduced CNS inflammation was documented that extended to the cornea, such that HSV corneal disease severity was reduced in susceptible BALB.CXCR3(-/-). In contrast, although survival of B6 and B6.CXCR3(-/-) mice was indistinguishable, B6.CXCR3(-/-) mice developed more severe corneal and periocular skin disease. CONCLUSIONS The effects of CXCR3 signaling in HSV infection are strongly dependent on mouse strain.
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MESH Headings
- Animals
- Brain Stem/metabolism
- Chemokine CXCL10
- Chemokine CXCL9
- Chemokines, CXC/physiology
- Cornea/virology
- Disease Susceptibility
- Encephalitis, Herpes Simplex/genetics
- Encephalitis, Herpes Simplex/mortality
- Encephalitis, Herpes Simplex/physiopathology
- Flow Cytometry
- Herpesvirus 1, Human/physiology
- Immunity, Innate
- Keratitis, Herpetic/genetics
- Keratitis, Herpetic/mortality
- Keratitis, Herpetic/physiopathology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Receptors, CXCR3
- Receptors, Chemokine/physiology
- Reverse Transcriptase Polymerase Chain Reaction
- Signal Transduction/physiology
- Skin Diseases, Viral/genetics
- Skin Diseases, Viral/mortality
- Skin Diseases, Viral/physiopathology
- Trigeminal Ganglion/metabolism
- Up-Regulation
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Affiliation(s)
- Patric Lundberg
- Division of Virology, Beckman Research Institute, City of Hope, Duarte, CA 91010, USA
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23
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Seeley WW, Marty FM, Holmes TM, Upchurch K, Soiffer RJ, Antin JH, Baden LR, Bromfield EB. Post-transplant acute limbic encephalitis: clinical features and relationship to HHV6. Neurology 2007; 69:156-65. [PMID: 17620548 DOI: 10.1212/01.wnl.0000265591.10200.d7] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Acute limbic encephalitis has been reported in the setting of treatment-related immunosuppression and attributed to human herpesvirus-6 (HHV6) infection. Clinical and laboratory features of the syndrome, however, have not been well characterized. METHODS We describe the clinical, EEG, MRI, and laboratory features of nine patients with acute limbic encephalitis after allogeneic hematopoietic stem cell transplantation (HSCT). To explore the relationship between HHV6 and this syndrome, we reviewed available CSF HHV6 PCR results from all HSCT patients seen at our center from March 17, 2003, through March 31, 2005. RESULTS Patients displayed a consistent and distinctive clinical syndrome featuring anterograde amnesia, the syndrome of inappropriate antidiuretic hormone secretion, mild CSF pleocytosis, and temporal EEG abnormalities, often reflecting clinical or subclinical seizures. MRI showed hyperintensities within the uncus, amygdala, entorhinal area, and hippocampus on T2, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) sequences. CSF PCR assays for HHV6 were positive in six of nine patients on initial lumbar puncture. All patients were treated with foscarnet or ganciclovir. Cognitive recovery varied among long-term survivors. The one brain autopsy showed limbic gliosis and profound neuronal loss in amygdala and hippocampus. Among 27 HSCT patients with CSF tested for HHV6 over a 2-year period, positive results occurred only in patients with clinical limbic encephalitis. CONCLUSIONS Patients undergoing allogeneic hematopoietic stem cell transplantation are at risk for post-transplant acute limbic encephalitis (PALE), a distinct neurologic syndrome. Treatment considerations should include aggressive seizure control and, possibly, antiviral therapy. PALE can be associated with the CSF presence of human herpesvirus-6, but the pathogenic role of the virus requires further exploration.
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MESH Headings
- Adult
- Amnesia, Anterograde/immunology
- Amnesia, Anterograde/physiopathology
- Amnesia, Anterograde/virology
- Amygdala/pathology
- Amygdala/physiopathology
- Antiviral Agents/therapeutic use
- Diabetes Insipidus/immunology
- Diabetes Insipidus/physiopathology
- Diabetes Insipidus/virology
- Encephalitis, Herpes Simplex/immunology
- Encephalitis, Herpes Simplex/physiopathology
- Encephalitis, Herpes Simplex/virology
- Epilepsy, Temporal Lobe/immunology
- Epilepsy, Temporal Lobe/physiopathology
- Epilepsy, Temporal Lobe/virology
- Hematopoietic Stem Cell Transplantation/adverse effects
- Herpesvirus 6, Human/immunology
- Hippocampus/pathology
- Hippocampus/physiopathology
- Humans
- Limbic Encephalitis/immunology
- Limbic Encephalitis/physiopathology
- Limbic Encephalitis/virology
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Postoperative Complications/immunology
- Postoperative Complications/physiopathology
- Postoperative Complications/virology
- Treatment Outcome
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Affiliation(s)
- W W Seeley
- Department of Neurology, Brigham & Women's Hospital, Boston, MA, USA.
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24
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25
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Apperly IA, Samson D, Chiavarino C, Bickerton WL, Humphreys GW. Testing the domain-specificity of a theory of mind deficit in brain-injured patients: Evidence for consistent performance on non-verbal, “reality-unknown” false belief and false photograph tasks. Cognition 2007; 103:300-21. [PMID: 16781700 DOI: 10.1016/j.cognition.2006.04.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 08/22/2005] [Accepted: 04/28/2006] [Indexed: 11/23/2022]
Abstract
To test the domain-specificity of "theory of mind" abilities we compared the performance of a case-series of 11 brain-lesioned patients on a recently developed test of false belief reasoning () and on a matched false photograph task, which did not require belief reasoning and which addressed problems with existing false photograph methods. A strikingly similar pattern of performance was shown across the false belief and false photograph tests. Patients who were selectively impaired on false belief tasks were also impaired on false photograph tasks; patients spared on false belief tasks also showed preserved performance with false photographs. In some cases the impairment on false belief and false photograph tasks coincided with good performance on control tasks matched for executive demands. We discuss whether the patients have a domain-specific deficit in reasoning about representations common to both false belief and false photograph tasks.
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Affiliation(s)
- Ian A Apperly
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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26
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Abstract
We report a patient with herpes simplex virus (HSV) encephalitis presenting as recurrent syncope due to sinus node arrest. Although the patient's initial presentation suggested a primary cardiac cause, an eventual diagnosis of HSV encephalitis was supported by computed tomography scan and magnetic resonance imaging, and confirmed by HSV polymerase chain reaction. The mechanism of cardiac arrhythmias in HSV encephalitis remains unclear; however, cardiac monitoring should be considered in all patients in whom the diagnosis is suspected. With diagnosis and appropriate management, a permanent pacemaker is generally not indicated. This case report highlights the importance of considering potentially reversible causes of collapse secondary to sinus node dysfunction beyond primary cardiac causes.
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MESH Headings
- Amygdala/pathology
- Amygdala/physiopathology
- Amygdala/virology
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Autonomic Pathways/physiopathology
- DNA, Viral/analysis
- Diagnosis, Differential
- Electrocardiography
- Encephalitis, Herpes Simplex/complications
- Encephalitis, Herpes Simplex/pathology
- Encephalitis, Herpes Simplex/physiopathology
- Female
- Hippocampus/pathology
- Hippocampus/physiopathology
- Hippocampus/virology
- Humans
- Magnetic Resonance Imaging
- Middle Aged
- Monitoring, Physiologic
- Sinus Arrest, Cardiac/etiology
- Sinus Arrest, Cardiac/physiopathology
- Syncope/etiology
- Syncope/physiopathology
- Temporal Lobe/pathology
- Temporal Lobe/physiopathology
- Temporal Lobe/virology
- Tomography, X-Ray Computed
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Affiliation(s)
- Belinda K Smith
- Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, 3065, Victoria, Australia.
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27
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Perez-Saldana MT, Vilar C, Geffner-Sclarsky D, Belenguer-Benavides A, Del Villar-Igea A, Gil-Fortuno M, Bahamonde D. [Meningoencephalomyelitis as the initial symptom of a brain tumour mimicking encephalitis due to herpes simplex virus: a case report]. Rev Neurol 2007; 44:348-52. [PMID: 17385171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Meningoencephalomyelitis can be due to a number of treatable causes. A tumoural aetiology is rare and they are generally malignant tumours with an ominous prognosis. We report a case of meningoencephalomyelitis that initially presented as encephalitis due to herpes simplex virus (HSV) and which was finally seen to be an anaplastic oligoastrocytoma. CASE REPORT We describe the case of a 68-year-old male with a history of just strong low back pain during the previous month, who was admitted to hospital because of progressive clinical symptoms involving cognitive impairment and myoclonias. The polymerase chain reaction for the cerebrospinal fluid was positive for HSV and magnetic resonance imaging revealed diffuse compromise of right temporal lobe, the spinal cord and the cervical meninges. The progressive deterioration of the patient despite treatment with acyclovir, anti-tuberculosis agents and with corticoids made it necessary to perform a biopsy study of the cervical meninges, the results of which suggested non-specific macromonocytic meningoencephalitis. The patient's condition continued to deteriorate until he died. The post-mortem examination revealed a grade III oligoastrocytoma in both temporal lobes, which had extended into the adjacent subarachnoid space and the cerebral and cervical leptomeninges. CONCLUSIONS Non-specific symptoms of low back pain can conceal a brain tumour. Attention is drawn to how infrequently it manifests clinically and in imaging studies as meningoencephalomyelitis due to direct tumoural invasion. This should be considered as a possibility when faced with a slowly progressing clinical picture that, despite the initial suspicion of encephalitis due to HSV, does not respond to the usual treatment.
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Affiliation(s)
- M T Perez-Saldana
- Sección de Neurología, Hospital General de Castellon, Castello de la Plana, Spain
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28
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29
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Gümüş H, Kumandaş S, Per H, Tahan F, Köklü E, Karakükçü M. Unusual presentation of herpes simplex virus encephalitis: bilateral thalamic involvement and normal imaging of early stage of the disease. Am J Emerg Med 2007; 25:87-9. [PMID: 17157690 DOI: 10.1016/j.ajem.2006.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 05/16/2006] [Accepted: 05/17/2006] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hakan Gümüş
- Department of Pediatric Neurology, Erciyes University Faculty of Medicine, 38039 Kayseri, Turkey.
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30
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Persson M, Brantefjord M, Liljeqvist JA, Bergström T, Hansson E, Rönnbäck L. Microglial GLT-1 is upregulated in response to herpes simplex virus infection to provide an antiviral defence via glutathione. Glia 2007; 55:1449-58. [PMID: 17680651 DOI: 10.1002/glia.20560] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Herpes simplex virus (HSV) can enter the central nervous system and cause encephalitis (HSV-1) or meningitis (HSV-2). Microglia, the immunocompetent cells of the central nervous system, are potentially able to detect viral infections. Microglia have been shown to express the glutamate transporter GLT-1 during pathological events, leading to increased microglial glutamate uptake and glutathione synthesis. This study aims to address the role of GLT-1 and glutathione, a major antioxidant with antiviral properties, during HSV infections. Using neuron-enriched mixed primary cultures from rat, it was found that microglia have higher resistance to HSV infections than neurons or astrocytes after 24 h incubation with HSV. Purified microglia in culture were used to further address this. It was found that microglia were able to detect HSV and responded by releasing tumor necrosis factor-alpha (TNF-alpha) and upregulating GLT-1 after 24 h incubation with 1 PFU/cell HSV-1 or HSV-2. Furthermore, the microglial glutathione levels were not significantly diminished after 24 h. Inhibition of the microglial glutathione synthesis with 200 microM buthionine sulfoximide (BSO) led to significantly more infected cells after 24 h incubation with 1 PFU/cell HSV-1 or HSV-2. These data indicate that the higher resistance in microglia against HSV infections may be due to the expression of GLT-1, which can maintain the glutathione levels and provide a mechanism for microglial self-defense against HSV.
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Affiliation(s)
- Mikael Persson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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31
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Sellner J, Simon F, Meyding-Lamade U, Leib SL. Herpes-simplex virus encephalitis is characterized by an early MMP-9 increase and collagen type IV degradation. Brain Res 2006; 1125:155-62. [PMID: 17109833 DOI: 10.1016/j.brainres.2006.09.093] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 09/26/2006] [Accepted: 09/27/2006] [Indexed: 11/22/2022]
Abstract
Cerebrovascular complications including cerebral edema, raised intracranial pressure and hemorrhage contribute to the high mortality and morbidity of herpes-simplex virus encephalitis (HSE). We examined changes of collagen type IV, the major constituent of the neurovascular matrix, together with expression and localization of matrix-degrading enzymes during the development of acute HSE. In an experimental model of focal HSE, we found that early, symptomatic HSE (3 days after infection) and acute, fully developed HSE (7 days after infection) are associated with significantly raised levels of matrix-metalloproteinase-9 (MMP-9) (both P<0.05). In situ zymography of brain sections revealed that the increase of MMP-9 was restricted to the cerebral vasculature in early HSE and further expanded towards the perivascular space and adjacent tissue in acute HSE. Around the cerebral vasculature, we observed that MMP-9 activity was insufficiently counterbalanced by its endogenous tissue inhibitor of MMP (TIMP) TIMP-1, resulting in loss of collagen type IV. Our findings suggest that MMP-9 is involved in the evolution of HSE by causing damage to the cerebral vasculature. The degradation of the neurovascular matrix in HSE facilitates the development of cerebrovascular complications and may represent a target for novel adjuvant treatment strategies.
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Affiliation(s)
- Johann Sellner
- Department of Neurology, University Hospital Bern, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland
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32
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Hamza MA, Higgins DM, Ruyechan WT. Herpes simplex virus type-1 latency inhibits dendritic growth in sympathetic neurons. Neurobiol Dis 2006; 24:367-73. [PMID: 16952455 DOI: 10.1016/j.nbd.2006.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 07/17/2006] [Accepted: 07/19/2006] [Indexed: 11/21/2022] Open
Abstract
Herpes simplex virus type-1 (HSV-1) initially infects mucoepithelial tissues of the orofacial region, the eye and to a lesser extent the genitalia. Subsequently, the virus is retrogradely transported through the axons of the sensory and sympathetic neurons to their nuclei, where the virus establishes a life-long latent infection. During this latency period, the viral genome is transcriptionally silent except for a single region encoding the latency-associated transcript (LAT). LAT has been shown to affect apoptosis, but little else is known regarding its effects on neurons. To understand how HSV-1 latency might affect dendrites in sympathetic neurons, we transfected primary cultures of sympathetic neurons obtained from rat embryos, with LAT expressing plasmids. LAT inhibited initial dendritic growth and induced dendritic retraction in sympathetic neurons. Latent HSV-1 infection of cultured sympathetic neurons inhibited dendritic growth indicating that this is likely also a consequence of natural infection.
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MESH Headings
- Animals
- Bone Morphogenetic Protein 7
- Bone Morphogenetic Proteins/genetics
- Bone Morphogenetic Proteins/metabolism
- Cell Differentiation/genetics
- Cells, Cultured
- Dendrites/pathology
- Dendrites/virology
- Encephalitis, Herpes Simplex/genetics
- Encephalitis, Herpes Simplex/metabolism
- Encephalitis, Herpes Simplex/physiopathology
- Ganglia, Sympathetic/growth & development
- Ganglia, Sympathetic/physiopathology
- Ganglia, Sympathetic/virology
- Gene Expression Regulation, Viral/genetics
- Genetic Vectors/genetics
- Green Fluorescent Proteins/genetics
- Herpes Simplex/genetics
- Herpes Simplex/metabolism
- Herpes Simplex/physiopathology
- Herpesvirus 1, Human/physiology
- MicroRNAs
- Rats
- Rats, Sprague-Dawley
- Signal Transduction/genetics
- Transfection
- Transforming Growth Factor beta/genetics
- Transforming Growth Factor beta/metabolism
- Viral Proteins/genetics
- Virus Latency/physiology
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Affiliation(s)
- Mohamed A Hamza
- Department of Pharmacology and Toxicology, University at Buffalo, SUNY, Buffalo, NY 14214, USA
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Giovannoni G, Chapman MD, Thompson EJ. The role of antibody affinity for specific antigens in the differential diagnosis of inflammatory nervous system disorders. J Neuroimmunol 2006; 180:29-32. [PMID: 16934336 DOI: 10.1016/j.jneuroim.2006.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 05/03/2006] [Accepted: 06/23/2006] [Indexed: 10/24/2022]
Abstract
Affinity maturation has previously been shown with assays for total IgG for specific antigens using the technique of competition by chaotropic ions. We have extended this technique to individual clones and followed the maturation of clones during the course of herpes encephalitis. This has important implications for our understanding of the pathogenesis of multiple sclerosis.
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Affiliation(s)
- Gavin Giovannoni
- Department of Neuroimmunology, Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Abstract
Herpes simplex encephalitis (HSE) remains one of the most devastating infections of the central nervous system despite available antiviral therapy. Children and adolescents account for approximately one third of all cases of HSE. Clinical diagnosis is suggested in the encephalopathic, febrile patient with focal neurologic signs. However, these clinical findings are not pathognomonic because numerous other diseases in the central nervous system can mimic HSE. Neurodiagnostic evaluation can provide support for the diagnosis by the demonstration of temporal lobe edema/hemorrhage by magnetic resonance image scan and spike and slow-wave activity on electroencephalogram. In the current era, the diagnostic gold standard is the detection of herpes simplex virus (HSV) DNA in the cerebrospinal fluid by polymerase chain reaction (PCR). Although PCR is an excellent test and preferable to brain biopsy, false negatives can occur early after disease onset. Acyclovir is the treatment of choice and is administered at 10 mg/kg every 8 h for 21 days. Even with early administration of therapy after the disease onset, nearly two thirds of survivors have significant residual neurologic deficits. Current investigative efforts are assessing the prognostic value of quantitative PCR detection of viral DNA at the onset of therapy as well as at the completion of therapy and the contribution of prolonged antiviral therapy to improved neurologic outcome.
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Affiliation(s)
- Richard J Whitley
- Department of Pediatrics, Infectious Diseases, The University of Alabama at Birmingham, 1600 Seventh Avenue, CHB 303, Birmingham, AL 35233, United States.
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Doepp F, Valdueza JM, Schreiber SJ. Serial ultrasound assessment of the basal vein of Rosenthal in HSV encephalitis. Ultrasound Med Biol 2006; 32:473-7. [PMID: 16616593 DOI: 10.1016/j.ultrasmedbio.2006.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 12/20/2005] [Accepted: 01/05/2006] [Indexed: 05/08/2023]
Abstract
Herpes simplex virus encephalitis (HSVE) typically affects the baso-temporal brain. The venous blood drainage of this region mainly occurs via the basal vein of Rosenthal (BVR), which can easily be monitored by transcranial color-coded duplex sonography (TCCS), and might be a useful parameter for the activity of the disease. Serial blood flow velocity (BFV) measurements of the BVR and the basal cerebral arteries were performed in five acute HSVE patients by means of transcranial color-coded duplex sonography (TCCS). Remarkable increased BFV of the BVR at the affected side was found in all patients, showing a maximum within the first 8 d of infection followed by a tendency toward normalisation during the next weeks. In comparison, changes of BFV in the basal cerebral arteries were much more heterogeneous. Our findings suggest that TCCS measurements of the BVR might be used as an additional diagnostic bed-side tool to evaluate patients with HSVE during the acute stage.
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Affiliation(s)
- Florian Doepp
- Department of Neurology, University Hospital Charité, Humboldt University, Berlin, Germany.
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Abstract
Background Encephalitis presenting as a change in mental status can be challenging to recognize in the primary care setting. However, early detection via a low threshold of suspicion can be useful, leading in turn to early treatment and improved survival. Case presentation We present a case which we consider relevant to primary care practitioners. The patient in question presented with relatively mild mental status changes, progressing to confusion, dysnomia and delirium over a period of three days. While infection did not appear to be the leading cause on her differential diagnosis, she was found on extensive workup to have encephalitis caused by Herpes Simplex Virus type 1. Conclusion The case is instructive for general practitioners and other clinicians to maintain vigilance for central nervous system (CNS) infections which may present atypically.
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Affiliation(s)
- Omar A Khan
- Department of Family Medicine, University of Vermont, Burlington, Vermont 05405, USA
| | - Allan Ramsay
- Department of Family Medicine, University of Vermont, Burlington, Vermont 05405, USA
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Mori I. [HSV infection of the central nervous system]. Nihon Rinsho 2006; 64 Suppl 3:198-201. [PMID: 16615467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Isamu Mori
- Department of Microbiology and Immunology, Aichi Medical University School of Medicine
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Reed LJ, Lasserson D, Marsden P, Bright P, Stanhope N, Kopelman MD. Correlations of regional cerebral metabolism with memory performance and executive function in patients with herpes encephalitis or frontal lobe lesions. Neuropsychology 2006; 19:555-65. [PMID: 16187874 DOI: 10.1037/0894-4105.19.5.555] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Cerebral [18F]fluorodeoxyglucose positron emission tomography (18FDG-PET) data from patients suffering amnesia following herpes encephalitis (n=7) or frontal lobe pathology (n=14) were compared with data from age-matched nonamnesic subjects (n=10). All subjects received structural MRI, resting 18FDG-PET scans, and neuropsychological evaluation. PET data were analyzed using complementary statistical parametric mapping and region-of-interest methods. Differential patterns of hypometabolism were found in patients relative to healthy controls. Factor analysis of the neuropsychological data revealed that memory performance was associated with retrosplenial and medial temporal metabolism, and executive function was associated with dorsolateral frontal metabolism. The association between memory performance and retrosplenial metabolism remained statistically significant after accounting for measures of cerebral atrophy using MRI. The significance of the retrosplenium as a major relay station between the thalamus and the medial temporal and frontal lobes--sensitive to changes in either--is discussed in the light of the findings.
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Affiliation(s)
- Laurence J Reed
- Division of Psychological Medicine, Institute of Psychiatry, and St Thomas's School of Medicine, St Thomas's Hospital, King's College London, London, United Kingdom.
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Mori I, Goshima F, Mizuno T, Imai Y, Kohsaka S, Ito H, Koide N, Yoshida T, Yokochi T, Kimura Y, Nishiyama Y. Axonal injury in experimental herpes simplex encephalitis. Brain Res 2006; 1057:186-90. [PMID: 16122712 DOI: 10.1016/j.brainres.2005.07.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Revised: 07/11/2005] [Accepted: 07/13/2005] [Indexed: 11/28/2022]
Abstract
Using beta-amyloid precursor protein immunolabeling, we have detected axonal injury in experimental herpes simplex encephalitis. beta-amyloid precursor protein-specific signals were found in the mouse brain as either puncta or axon-like structures. They appeared where infected neurons were undergoing apoptosis and Iba1-immunopositive microglia transformed themselves into macrophages. These results show, for the first time, that axonal injury, i.e., functional disturbance of the fast axonal transport, can take place during the course of acute viral encephalitis.
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Affiliation(s)
- Isamu Mori
- Department of Microbiology and Immunology, Aichi Medical University, School of Medicine, Aichi 480-1195, Japan.
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Affiliation(s)
- Markus Ploner
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany.
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Abstract
A 74-year-old woman developed vertigo and jerk nystagmus to the left with normal cerebral imaging. Three days later she developed fever, altered mental state and left medial temporal lobe hypodensity, confirmed on lumbar puncture to be due to herpes simplex type 1 encephalitis. We propose that the patient had vestibular neuronitis caused by HSV-1 that progressed to ipsilateral temporal lobe encephalitis.
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Affiliation(s)
- Stephen J Philpot
- Department of Neurology, Cairns Base Hospital and James Cook University, Cairns, Queensland, Australia
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Sköldenberg B, Aurelius E, Hjalmarsson A, Sabri F, Forsgren M, Andersson B, Linde A, Strannegård O, Studahl M, Hagberg L, Rosengren L. Incidence and pathogenesis of clinical relapse after herpes simplex encephalitis in adults. J Neurol 2005; 253:163-70. [PMID: 16222428 DOI: 10.1007/s00415-005-0941-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Revised: 05/11/2005] [Accepted: 05/17/2005] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To study the occurrence of relapse of herpes simplex encephalitis (HSE) and to find out whether soluble activity markers in cerebrospinal fluid (CSF) indicate direct viral or immune- mediated events. METHODS A consecutive series of 32 adult survivors of HSE were followed to determine the incidence of clinical relapse of HSE. Four patients had neurological deterioration interpreted as relapsing HSE. Four non-relapsing HSE cases were selected as matched controls. Fifty nine batched, paired CSF and serum samples from the eight HSE patients were analysed for soluble activity markers, predominantly cytokines and mediators (interferon-gamma, soluble CD8, tumour necrosis factor-alpha, and interleukin-10), amount of HSV-DNA and markers of glial and neuronal destruction (neurofilament protein, glial fibrillary acidic protein, S-100-beta, and neuron specific enolase). RESULTS Relapse of HSE was diagnosed in 3 of 26 (12 %) acyclovir-treated patients (5 episodes during 6.1 years of followup) and in 1 of 6 vidarabine-recipients. All relapses occurred from 1 to 4 months after acute HSE, except for a second relapse after 3.3 years in one patient. Computer tomography at relapses revealed few abnormalities apart from those found during the primary disease. Intravenous acyclovir and corticosteroids were given for 7-21 days in all the relapse patients. All relapse patients seemed to recover to the pre-relapse condition. HSV-DNA was demonstrated in CSF in all patients during the acute stage but not in any of 13 CSF samples taken during relapse phases. The HSV viral load during the acute stage of HSE was not higher or of longer duration in the relapsing patients than in the non-relapsing HSE controls. The levels of sCD8 were increased in nearly all CSF samples tested with peaks of sCD8 at one month of acute HSE. In all episodes of relapse, sCD8 peaks were detected during the first week at high levels. CSF levels of neuron-specific enolase, S-100 and glial fibrillary acidic protein were markedly lower at relapse than at the acute stage of HSV-1 encephalitis. CONCLUSION The lack of demonstrable HSV DNA in CSF, the lack of acute CSF signs and the lack of signs of neural and glia cells destruction indicate that a direct viral cytotoxicity is not the major pathogenic mechanism in relapse. Instead, the pronounced CSF proinflammatory immunological response and the relative lack of CSF anti-inflammatory cytokine IL-10 response suggest immunologically-mediated pathogenicity.
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Affiliation(s)
- B Sköldenberg
- Karolinska Institutet, Division of Infectious Diseases, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
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Abstract
A 28-year-old woman presented with a one day history of high fever and partial seizures with secondary generalization. This was preceded by a three week history of headache, ataxia, and fatigue. An initial computed tomogram head scan showed a low density mass lesion in the right frontal operculum without enhancement. On the next day, a repeat scan showed a new frontopolar, expansile, low density cortical lesion (Figure 1A) suggestive of encephalitis. Cerebrospinal fluid showed a pleocytosis of 311 mononuclear white blood cell count per μL and an elevated protein of 1.57 g/L. She received intravenous acyclovir and antibiotics. She remained febrile and became mute. A magnetic resonance (MR) scan under general anesthesia on her fourth hospital day showed frontal and perisylvian lesions with restricted diffusion (Figure 1B - D and Figure 2). A right frontal brain biopsy showed meningoencephalitis and immunohistochemical staining was positive for herpes simplex virus (HSV) antigen (Figure 3). Subsequently, HSV-1 DNA was demonstrated in both cerebrospinal fluid and brain tissue with polymerase chain amplification. She improved after a course of intravenous therapy with acyclovir with residual frontal lobe signs, including marked executive dysfunction, and her speech became normal.
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Affiliation(s)
- Sean W Taylor
- Department of Medicine (Neurology), Queen's University, Kingston, Ontario, Canada
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De Tiège X, De Laet C, Mazoin N, Christophe C, Mewasingh LD, Wetzburger C, Dan B. Postinfectious immune-mediated encephalitis after pediatric herpes simplex encephalitis. Brain Dev 2005; 27:304-7. [PMID: 15862196 DOI: 10.1016/j.braindev.2004.07.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Revised: 06/09/2004] [Accepted: 07/22/2004] [Indexed: 10/26/2022]
Abstract
We report a 3-year-old patient who presented a secondary acute neurological deterioration clinically characterized by a partial Kluver-Bucy syndrome, 1 month after the onset of herpes simplex encephalitis. This episode is unlikely due to continuation or resumption of cerebral viral replication but might be related to an immune-inflammatory process. In children, postinfectious immune-mediated encephalitis occurring after HSE are usually clinically characterized by choreoathetoid movements. This type of movement disorder was, however, not observed in this patient. On the basis of this case and a review of the literature, we hypothesize the existence of a spectrum of secondary immune-mediated process triggered by herpes simplex virus cerebral infection ranging from asymptomatic cases with diffuse white matter involvement to secondary acute neurological deteriorations with or without extrapyramidal features.
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Affiliation(s)
- Xavier De Tiège
- Department of Pediatric Neurology, ULB-Hôpital Erasme Brussels, Brussels, Belgium.
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45
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Abstract
A comprehensive battery of neuropsychological tests designed to assess primary cognitive functions, including language and semantic memory, was given to MG, a patient with confirmed herpes simplex virus encephalitis. MG's initial jargon aphasia resolved over time to leave her with a mild phonological impairment. She had a very mild amnesia that was worse for verbal material and a category-specific impairment of semantic memory. This latter impairment resulted in a significant anomia that was worse for manmade/artefact items than for animate kinds. Her naming difficulties were associated with a mild impairment in comprehension that was not specific to category or feature type. MRI revealed a strongly asymmetric and atypical distribution of pathology in MG with the disease affecting the left medial temporal lobe, temporal pole, left frontotemporal and temporoparietal regions.
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Affiliation(s)
- C Lowe
- Department of Psychology, University of Manchester, UK.
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46
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Sellner J, Lenhard T, Haas J, Einsiedel RV, Meyding-Lamadé U. Differential mRNA expression of neurotrophic factors GDNF, BDNF, and NT-3 in experimental herpes simplex virus encephalitis. ACTA ACUST UNITED AC 2005; 137:267-71. [PMID: 15950786 DOI: 10.1016/j.molbrainres.2005.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2004] [Revised: 02/26/2005] [Accepted: 03/13/2005] [Indexed: 01/26/2023]
Abstract
Glial cell line-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) mRNA levels were studied in the course of murine herpes simplex virus encephalitis. Induction of GNDF and NT-3 (both P < 0.05) was found during acute encephalitis. Despite absence of clinical impairment, both neurotrophic factors were overexpressed 2 months (NT-3) and 6 months (GDNF) following infection (both P < 0.05). Neurotrophic factors play an important role in neuronal survival and recovery after acute injury to the central nervous system (CNS) and may represent an additional therapeutic target for treatment of viral encephalitis.
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Affiliation(s)
- Johann Sellner
- Department of Neurology, Ruprecht-Karls-University Heidelberg, D-69120 Heidelberg, Germany.
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Mito Y, Yoshida K, Yabe I, Hirotani M, Tashiro K, Kikuchi S, Sasaki H. Herpes simplex virus encephalitis presenting with cerebral infarction-like signs and neuroimages. Hokkaido Igaku Zasshi 2005; 80:185-9. [PMID: 15835300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A patient with an atypical presentation of herpes simplex virus (HSV) encephalitis mimicking acute cerebral infarction was reported. A 48-year-old man developed left-sided hemiparesis, convulsive seizures, and loss of consciousness. Brain magnetic resonance imaging revealed high intensity areas in the right frontal to parietal lobes on T2-weighted and diffusion-weighted images. Soon after admission with suspected cerebral infarction of the right middle cerebral artery region, the patient had high fever with frequent seizures and severe loss of consciousness. Laboratory findings including cerebrospinal fluid established a diagnosis of HSV encephalitis, and a state of apalic syndrome persisted despite aggressive antiviral therapy.
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Affiliation(s)
- Yasunori Mito
- Neurology, Asahikawa Red Cross Hospital, Asahikawa 070-8530, Japan
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Weidenfeld J, Itzik A, Goshen I, Yirmiya R, Ben-Hur T. Role of the central amygdala in modulating the pituitary-adrenocortical and clinical responses in experimental herpes simplex virus-1 encephalitis. Neuroendocrinology 2005; 81:267-72. [PMID: 16131813 DOI: 10.1159/000087924] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 07/07/2005] [Indexed: 11/19/2022]
Abstract
The amygdala is known to regulate neuroendocrine and behavioral responses to a variety of stimuli. Herpes simplex virus-1 (HSV-1) is the common cause of viral encephalitis, manifested by hypothalamic-pituitary-adrenal (HPA) axis activation, fever, hypermotor activity and aggression. We examined here the role of the central amygdala (cAMG) in regulating the HPA axis function, febrile and behavioral responses to HSV-1 infection in rats. Bilateral electrolytic lesions were performed in the cAMG. HSV-1 encephalitis was induced by intracerebroventricular (ICV) inoculation of purified virions. Motor activity and body temperature were examined by a biotelemetric system. ICV inoculation of HSV-1 caused a marked time-dependent increase in serum corticotropin (ACTH) and corticosterone at 4 and 24 h post-infection. These responses were attenuated in rats with bilateral lesions of the cAMG. HSV-1 infection induced fever, motor hyperactivity and aggressive behavior. These responses were also attenuated in rats with cAMG lesions. The cAMG plays an important role in mediating the neuroendocrine, febrile and behavioral responses to HSV-1 infection.
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Affiliation(s)
- Joseph Weidenfeld
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
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Abstract
Herpes simplex encephalitis is usually a monophasic acute illness but can cause chronic disease, particularly in children. Little information is available as to the histological substrate. We report the findings in 3 children. In 2 children, herpes encephalitis had occurred during the first 2 years, but both later developed intractable epilepsy that led to neurosurgery. The biopsies showed chronic granulomatous inflammation with foci of mineralization. One child made a good post-operative recovery. The other was found post-operatively to have herpes simplex virus type 1 (HSV-1) DNA and elevated titers of HSV IgM antibodies in the CSE He was given acyclovir but after initial improvement developed hemiparesis, with extensive signal change on MRI. Repeat biopsy revealed florid granulomatous inflammation with necrosis. The third patient was an infant who had had a cutaneous facial HSV-2 eruption soon after birth. This was treated with topical acyclovir, after which she remained well until 2 months, when she presented with a relatively non-specific illness, developed blisters of the right hand and foot, and died a few days later. Necropsy revealed severe granulomatous encephalitis, most extensive in the temporal lobe and insula, and associated with mineralization. Our findings indicate that herpes simplex encephalitis in children can be complicated by chronic granulomatous inflammation with mineralization. This pattern of disease may be an under-recognized complication of herpes simplex infection during the first few years of life.
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Affiliation(s)
- Seth Love
- Department of Neuropathology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, United Kingdom.
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50
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Gaviani P, Leone M, Mula M, Naldi P, Macchiarulo E, Brustia D, Monaco F. Progression of MRI abnormalities in herpes simplex encephalitis despite clinical improvement: natural history or disease progression? Neurol Sci 2004; 25:104-7. [PMID: 15221631 DOI: 10.1007/s10072-004-0240-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 04/18/2004] [Indexed: 11/27/2022]
Abstract
Herpes simplex virus encephalitis (HSVE) is associated with a high mortality rate and a high probability of neurological sequelae. Good results are obtained when HSVE is promptly diagnosed and treated with acyclovir. We present a 71-year-old woman with clinically diagnosed HSVE, confirmed by PCR detection of HSV-1 DNA in the cerebrospinal fluid. She was treated with acyclovir (30 mg/kg day) for two weeks. Clinical and neuropsychological assessments 6 months after admission were normal; however MRI at 2, 6 and 12 months showed progressive deterioration with extensive white matter and cortical damage. Imaging studies of a cohort of patients surviving PCR-confirmed HSVE are needed to determine whether this pattern is occasional or a frequent form of progression.
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Affiliation(s)
- P Gaviani
- Neurological Clinic, Ospedale Maggiore della Carità, A. Avogadro University of Eastern Piedmont, Corso Mazzini 18, I-28100 Novara, Italy.
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