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PubMed2000

An adult case of mumps brainstem encephalitis.

We present an adult case of mumps brainstem encephalitis. He was successfully treated with steroid pulse therapy and recovered completely except for persistent dysuria. He had not been vaccinated and had no history of acute mumps infection. We consider that encephalitis in this case was caused by a reversible autoimmune process triggered by mumps infection. We emphasize the usefulness of pulse therapy for the treatment of some cases of mumps brainstem encephalitis in addition to the importance of mumps vaccination to prevent such a severe complication as encephalitis.

Adult↗
PubMed1988

CT, MR, and pathology in HIV encephalitis and meningitis.

The value and limitations of CT and MR in human immunodeficiency virus (HIV) infection of the brain was determined by a retrospective analysis of the CT scans (22) and MR images (7) in 22 patients with pathologically proved HIV encephalitis (21) or meningitis (1). Our clinical-radiologic-pathologic correlation suggested that, especially in the early stages of the disease, CT and MR were relatively insensitive in detecting the primary changes of HIV encephalitis. The multiple bilateral diffuse microscopic glial nodules with multinucleated giant cells of HIV found at autopsy in both gray and white matter were usually not directly visualized by either CT or MR. Secondary, nonspecific changes, however, were seen. These included cortical atrophy, found in virtually all patients with HIV encephalitis, and HIV-induced foci of demyelination found in the minority of cases. On CT the latter were seen in the white matter as nonenhancing, nonmass-producing areas of low density; on MR they were seen as frequently progressive high-intensity signal abnormalities on T2-weighted images, usually in the periventricular white matter and centrum semiovale. MR was more sensitive in detecting these demyelinative lesions than was CT. The clinical diagnosis of HIV encephalitis usually antedated the radiographic diagnosis. In HIV meningitis, contrast CT was more definitive than MR, showing striking enhancement of the subarachnoid spaces, although MR was more sensitive in detecting the secondary parenchymal changes.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Rasmussen's encephalitis: neuroimaging findings in four patients.

Rasmussen's encephalitis is a devastating disease of childhood causing progressive neurologic deficits and intractable seizure activity. Patients frequently have episodes of epilepsia partialis continua and, much less frequently, generalized status epilepticus. The seizures are intractable despite aggressive medical management. In advanced cases, hemispherectomy appears to be the only option to control the seizures. Permanent physical and mental impairments are inevitable. The cause of this disease is unknown, although pathologic specimens demonstrate nonspecific changes that are compatible with viral encephalitis. The progressive brain damage is typically so insidious in onset and gradual in course that it is difficult to make an accurate diagnosis on the basis of clinical evidence. We retrospectively evaluated the CT, xenon CT, positron emission tomographic, and MR neuroimaging findings in four young patients with pathologically suspected Rasmussen's encephalitis (three patients had CT scans, two had xenon CT scans, two had MR scans, and one had a positron emission tomogram). All studies showed abnormalities of the involved cerebral hemisphere: CT and MR revealed nonspecific atrophy, xenon CT showed decreased cerebral blood flow, and positron emission tomography revealed a hypometabolic state. Rasmussen's encephalitis is a diagnosis of exclusion; however, the information obtained from neuroimaging studies in combination with the clinical course should suggest this disorder.

Adolescent↗
PubMed2000

Herpes simplex replication and dissemination is not increased by corticosteroid treatment in a rat model of focal Herpes encephalitis.

Neurological damage in Herpes simplex type 1 encephalitis results from neuronal cell death secondary to viral invasion, and from inflammatory changes and cerebral oedema secondary to the immune response to the virus. Corticosteroids could have an important role in the management of Herpes simplex encephalitis because their anti-inflammatory action reduces cerebral oedema. However their use has been limited by concerns that their immunosuppressive actions could increase viral replication and spread. The present study examined this issue in a rat model in which injection of HSV-1 into the cervical vagus nerve produced a well-defined focal encephalitis, characterised by an orderly progression of the virus through central neural pathways connected with vagal afferent termination sites in the medulla oblongata. After injection of HSV-1, rats were treated twice a day, either with vehicle (saline, 400 microl i.p.), with acyclovir (30 mg/kg i.p.), with dexamethasone (5 mg/kg i.p.), or with both acyclovir and dexamethasone. Animals were sacrificed after 72 h, and viral load in different brain regions was quantified by computer-assisted measurement of the area occupied by immunohistochemical reaction product. Treatment with acyclovir reduced viral load to 17 +/- 5% of the saline value (P < 0.01). After dexamethasone treatment, the viral load (63 +/- 13% of the saline value) was also reduced (P < 0.05). Treatment with both acyclovir and dexamethasone reduced viral load to 26 +/- 8% of the saline value (P < 0.01 compared with saline, and P > 0.05 compared to acyclovir alone). Our results confirm the effectiveness of acyclovir in a new model of HSV-1 infection, and provide evidence that corticosteroids do not inhibit the antiviral action of acyclovir. In addition corticosteroids may decrease the extent of infection in their own right. The acute time course studied in our model parallels the time course of acute Herpes simplex encephalitis in humans. Our data suggests that corticosteroids are not detrimental when combined with acyclovir in the management of this condition.

Acyclovir↗
PubMed1996

Magnetic resonance brain imaging lacks sensitivity for AIDS associated cytomegalovirus encephalitis.

Six patients are presented who died with active cytomegalovirus (CMV) encephalitis in whom brain MR scans within 25 days of death failed to reveal distinctive findings suggesting the diagnosis of CMV encephalitis. While MR scanning is crucial to evulation of AIDS patients developing neurologic complications, it is not sensitive to the presence of CMV encephalitis even when it is quite severe. The diagnosis of CMV encephalitis during life rests on characteristic clinical findings supported by a typical laboratory measures including the presence of CMV DNA in cerebrospinal fluid as detected by polymerase chain reaction.

AIDS-Related Opportunistic Infections↗
PubMed1988

Intracranial pressure and outcome in adult encephalitis.

The relationship between intracranial pressure (ICP) and outcome was studied in 10 adults with encephalitis. Eight had biopsy-proven herpes simplex encephalitis, one had acute hemorrhagic leukoencephalitis, and in one case the cause of encephalitis was unknown. Monitoring of ICP was instituted because of clinical deterioration or computerized tomography evidence of brain swelling, and was begun a mean of 7 days after the onset of symptoms and continued for a mean of 9 days. All five survivors, but only one of the five fatalities, had an initial ICP of less than 12 mm Hg (p less than 0.05). Four patients with a mean daily ICP of less than 20 mm Hg survived, whereas five of six patients with higher ICP's died (p less than 0.05). Peak ICP did not occur until the 12th day of illness on average. The Glasgow Coma Scale score at the time the ICP monitor was inserted did not correlate with outcome. Intracranial pressure monitoring in severe encephalitis may be a useful adjunct for therapy and an indicator of prognosis.

Adult↗
PubMed1997

Fatal encephalitis and meningitis at the Gold Coast Hospital, 1980 to 1996.

The recent association of a fatal human case of encephalitis with a newly identified lyssavirus apparently acquired from a native Australian bat has highlighted the possibility that previous human infections have passed urecognised. Infected bats have been identified on the Queensland Gold Coast where extensive close contact between bats and humans has occurred for many years. In an attempt to identify nervously unrecognised cases of fatal lyssavirus encephalitis, the medical records of the Gold Coast Hospital over a 16 years period from 1980 to 1996 were reviewed. Of 20 cases coded as 'encephalitis' or 'meningitis' where death occurred, none was consistent with an encephalitis due to an unidentified virus.

Animals↗
PubMed1985

Investigations of the vertebrate hosts of eastern equine encephalitis during an epizootic in Michigan, 1980.

A study was undertaken to investigate an increase in reported cases of clinical encephalitis due to eastern equine encephalitis (EEE) virus in horses and to determine the natural vertebrate hosts of that virus. Horses, birds, and small mammals were sampled at sites in a contiguous area in St. Joseph and Kalamazoo counties, Michigan, from 25 August to 5 September 1980. Serum samples from four horses acutely ill with encephalitis and 16 of 39 pasture mates of ill horses had neutralizing (N) antibody against EEE virus (46.5%); no viruses were isolated from these 43 sera. None of 24 draft horses from a site in St. Joseph County 12 km southeast of the affected sites had EEE antibody. A strain of Cache Valley virus was isolated from the blood of one of the 24 draft horses. No viruses were isolated, and no antibodies to EEE virus were detected in 28 blood samples from small mammals captured at sites where equine cases of encephalitis were occurring. Six strains of EEE virus, five of Highlands J virus, and one of Flanders virus were isolated from the blood of 401 wild birds belonging to 42 species captured at eight sites in both counties. A total of 29.9% of the wild birds had EEE antibody. Five species of domestic birds, mostly chickens and ring-necked pheasants, were sampled in both counties. Six strains of EEE virus were isolated from 152 ring-necked pheasants; these included three isolates from the brains of dead birds. About 13% of 51 pheasants tested from two small flocks in backyard pens in Kalamazoo County and 9% of 103 pheasants tested from a large game farm in St. Joseph County had antibody to EEE virus. The source of the EEE virus and the factors responsible for this epizootic are unknown; however, the epizootic probably represented an explosive expansion of an enzootic level of virus transmission.

Alphavirus↗
PubMed1991

Murray Valley encephalitis acquired in Western Australia.

OBJECTIVE: To report a recent fatal case of encephalitis associated with evidence of Murray Valley encephalitis virus infection, only the second fatality from this infection in Western Australia. CLINICAL FEATURES: An 18-month-old Aboriginal boy was admitted to hospital in northwest Western Australia with proven Haemophilus influenzae type b meningitis. INTERVENTION AND OUTCOME: After an initial good response to antibiotics (amoxycillin and cefotaxime) he relapsed and died with evidence of encephalitis. Analysis of serum showed a high titre of antibody to Murray Valley encephalitis (MVE) virus with the presence of specific IgM. No evidence was found for other infective agents. CONCLUSION: It is likely that this child died from MVE which followed his bacterial meningitis. Of the strains of mosquitoes trapped in the area of suspected infection 77.8% were Culex annulirostris, the major vector species for MVE. No MVE virus was isolated from these mosquitoes, but serum from one of the sentinel chickens contained MVE virus antibodies, indicating the presence of the virus in that region.

Encephalitis↗
PubMed1993

Australian encephalitis in Western Australia, 1978-1991.

OBJECTIVE: To review the various clinical manifestations of Murray Valley encephalitis (MVE) or Kunjin virus encephalitis in patients in Western Australia. DESIGN: Review of clinical records, 1978 to 1991. PATIENTS: Of 26 reported cases of Australian encephalitis, four were excluded from study because the patient's symptoms were not definitely associated with MVE virus or Kunjin virus infection. Two further cases of MVE were not reviewed as case records were not available. Of the remaining 20 patients, 18 had MVE and two had Kunjin virus encephalitis. RESULTS: Sixteen cases were in the Kimberley, a tropical region where the viruses are endemic. Four were in the subtropical Pilbara and Gascoyne regions. Thirteen of the 20 cases were in Aborigines, of whom 11 were children. The seven non-Aboriginal patients were adults. Seventeen of 20 cases were in males. The range of neurological disease and outcome was similar to that in previously reported cases, with convulsions, brainstem disease or respiratory failure in severe and fatal cases, and involvement of the spinal cord, cranial nerve or cerebellum in the moderate cases. One mild cases without neurological involvement was caused by Kunjin virus. CONCLUSIONS: The poor outcome in young Aboriginal children indicated that disease resulting from exposure early in life was more likely to be severe. The disease in adults, irrespective of facial background, was similar to that in cases reported previously from south-eastern Australia, but generally milder.

Adolescent↗
PubMed1999

[Seroprevalence of Central European tick-borne encephalitis in the Lorraine region].

BACKGROUND: Central European encephalitis, caused by the tick-borne encephalitis virus (TBEV), is exceptional in France. Most cases have been described in Alsace. As 2 cases of tick-borne encephalitis were diagnosed in the Nancy region, a seroepidemiological survey was conducted in the Lorraine region (Meurthe & Moselle, Moselle, Vosges, Meuse) in 1996. METHODS: The survey was proposed to approximately 1,000 persons attending preventive medicine clinics. The subjects were asked to fill out a self-administered questionnaire on factors related to tick bite exposure and underwent TBEV serology tests. RESULTS: 1,777 subjects participated in the survey. Half of them lived in rural areas, 91% had occasional or regular contact with the forest environment and 21% had experienced tick bites. TBEV serology (IgG) was positive in 19 subjects (1.6%; 95% CI: 0.9%-2.3%); 9 sera were positive on Western blot (0.76). No IgM positive serum was found. Seroprevalence was higher in subjects with a past history of tick bites compared with the others (2.9% vs 1.3%, p = 0.074). CONCLUSION: The low seroprevalence of TBEV in this survey is not in favor of widespread tick-bite encephalitis virus in the Lorraine general population.

Encephalitis, Tick-Borne↗
PubMed1999

[Severe forms of rubella encephalitis: arguments for a better vaccination policy].

BACKGROUND: Two cases of rubella encephalitis in young adults are reported. CASES REPORTS: 2 patients, 19 and 16-year-old, presented with severe encephalitis. One required mechanical ventilation. Neither were vaccinated against rubella. MRI scan of the brain was normal. The diagnosis was confirmed by serology. Good recovery was noted in both patients. DISCUSSION: Both cases of rubella encephalitis occurring in young adults illustrate the severity of this rare disease. As already shown in Finland, improvement with the French vaccination policy should lead to the prevention of rubella encephalitis.

Adolescent↗
PubMed2000

Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess.

Central nervous system infections in adolescents range from the diffuse cerebritis of encephalitis to the regional inflammation of meningitis, and very focal disease of brain abscess. Clinical presentations reflect this wide spectrum, with encephalitis primarily characterized by altered mental status, meningitis by fever, headache, and neck stiffness, and brain abscess manifesting localizing findings. Encephalitis and viral meningitis are frequently caused by the seasonal enteroviruses and arboviruses, while most adolescent bacterial meningitis is due to Neisseria meningitidis and Streptococcus pneumoniae. The microbiology of brain abscess reflects underlying host risk factors. Gram-positive cocci are seen in patients with congenital heart disease, while respiratory flora including anaerobes are associated with sinus or otic disease. Lumbar puncture to characterize and culture the CSF remains the optimal test for the diagnosis and management of encephalitis and meningitis, while CT-guided needle biopsy may be both diagnostic and therapeutic for brain abscesses. New diagnostic tests include the use of PCR. A variety of safe and effective treatment regimens exists for most bacterial infections as well as for some herpesvirus infections. New vaccines are under study to further control bacterial meningitis.

Adolescent↗
PubMedDate not supplied

Epstein-Barr virus encephalitis in children.

Fourteen children with Epstein-Barr virus (EBV) encephalitis admitted to our pediatric department during the period 1988 to 1998 were collected and reviewed to characterize the clinical, laboratory and neuroradiological findings. There were 7 boys and 7 girls. The age of onset ranged from 10 months to 14 years. Among them, 5 patients belonged to Alice in Wonderland syndrome, 5 were diagnosed as acute viral encephalitis, 1 presented with acute meningoencephalitis followed by cerebellitis, the remaining 3 cases attributed to acute disseminated encephalomyelitis. The main symptoms were fever (43%), seizure (36%), bizarre behavior (31%), headache (21%) and metamorphopsia (36%). The presenting signs included altered consciousness (50%), meningeal sign (14%), bulbar sign (14%), cerebellar sign (7%), and cranial nerve palsy (7%). Classic findings of infectious mononucleosis were obscure. The laboratory data showed the existence of atypical lymphocyte in only one case but positive serology for EBV infection in all patients. Pleocytosis was found in 3 (30%) of 10 patients examined. Eight (67%) of 12 patients had nonspecific electroencephalographic changes in the acute stage. Computed tomography (CT) scans were abnormal in 2 (40%) of 5 patients tested; while magnetic resonance image (MRI) disclosed lesions in 5 (56%) of 9 patients, with abnormal signals in various parts of the brain. Single photon emission computed tomography (SPECT) brain scan showed abnormal perfusion lesions in 3 (75%) of 4 patients studied. The results demonstrate the diversity of neurological manifestations of EBV encephalitis. EBV should be considered in any acute neurological illness of uncertain etiology in the pediatric population. While MRI remains the image of choice in EBV encephalitis, SPECT detects the abnormal perfusion more precisely in a substantial number of patients.

Adolescent↗
PubMed2000

Chronic focal encephalitis (Rasmussen's syndrome) in an adult.

Chronic focal encephalitis in adults is rare. Here we report a case of chronic focal encephalitis with epilepsy in a man. A 53-year-old man was admitted to our hospital because of right-sided focal seizures and epilepticus partialis continua. Brain imaging studies demonstrated progressive, focal, left cerebral atrophy. Prominent degenerative changes including neuronal loss and astrocytic gliosis were found on brain biopsy. Although the characteristics were typical of Rasmussen's encephalitis, unlike chronic focal encephalitis in children, his seizures were easily controlled by traditional antiepileptic therapy.

Chronic Disease↗
PubMed2000

Influence of type 2 T cell responses on the severity of encephalitis associated with influenza virus infection.

The role of type 2 T cell responses on the severity of post-infectious encephalitis was investigated in a mouse model of influenza virus infection. When mice were infected intracerebrally with 3.0 LD(50) of A/NWS33 strain of influenza virus, they all showed clinical signs of encephalitis, and 90% of them died within 10 days of the infection. However, the post-infectious encephalitis was not demonstrated in mice exposed to 0.5 LD50 of the same virus. The mortality rates of mice infected with 0.5 LD(50) of the virus were increased to levels observed in mice exposed to 3.0 LD(50) of influenza virus infection, after the administration of a mixture of interleukin (IL)-4 and IL-10 (2 ng/mouse each; immediately, 1 and 2 days after the infection). In contrast, mortality rates of mice exposed to 3.0 LD(50) of influenza virus were substantially decreased when these mice were treated with a mixture of monoclonal antibodies directed against IL-4 and IL-10. A predominance of type 2 T cell responses was demonstrated in splenic T cells of mice infected with 3.0 LD(50) of influenza virus, although these responses were minimal in mice infected with 0.5 LD(50) of the virus. After the treatment with the mixture of type 2 cytokines, an increase in the type 2 T cell responses in mice exposed to 0.5 LD(50) of the virus was shown. These results indicate that type 2 T cell responses associated with the viral infection play an important role in the severity of post-infectious encephalitis induced in mice by the intracerebral infection of influenza A virus.

Animals↗
PubMed2000

Encephalitis in the 21 st century.

As the 21st century begins, several outbreaks of encephalitis have been reported. An examination of these outbreaks brings into focus important epidemiological developments. Specifically, urbanization and encroachment on natural environments, the ease of world travel, and global trade can lead to spread of vectors and viruses from the developing world to the developed world. This review focuses on two recent epidemics of encephalitis: West Nile virus encephalitis in the eastern United States and Nipah virus encephalitis in Malaysia and Singapore. These examples demonstrate spread of a known viral agent from an endemic area to an area in which it had not previously been found and identification of a new viral agent. Infectious diseases in the developed world once considered "exotic" are now potential threats to all patients.

Encephalitis, Viral↗
PubMed2000

[A study of measles encephalitis with focal changes on MRI, auditory agnosia and expressive aphasia].

Acute measles encephalitis is a typical parainfectious encephalitis in which the brain is diffusely affected clinically and neuropathologically. We present here a 5-year-old case of measles encephalitis with intractable seizures, bitemporal MRI abnormalities, and neurological sequelae of auditory agnosia and aphasia. Pathophysiology of the focal MRI lesions and of expressive aphasia due to auditory agnosia was discussed. We stressed that the status convulsions and its ischemic effect played an important role on the development of the focal lesions rather than focal encephalitis or ADEM. In the course of auditory agnosia and acquired aphasia, the patient transiently expressed some meaningful words. The significance of this episode was discussed based on the sequential changes of symptoms and neuroimaging findings.

Acute Disease↗