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PubMed1997

Subcortical type cognitive impairment in herpes zoster encephalitis.

Nine immunocompetent patients with acute herpes zoster encephalitis (HZE) were studied with the help of neurological investigations. All patients were treated with acyclovir. Neuropsychological performance was compared with that of a group of 16 healthy controls. Computed tomography of the head showed infarct-like hypodense lesions in two patients, involving the internal capsule in one case and the temporoparietal cortex and white matter in another. Hypoperfusion shown by single photon emission computed tomography, mostly involving the frontal areas bilaterally, was seen in six of the seven patients examined. Hyperperfusion as seen in herpes simplex encephalitis was not encountered. One patient remained mildly demented, but all the other patients recovered relatively well. Neuropsychological examination after acyclovir treatment showed a decline in memory and speed of cognitive processes, without circumscribed neuropsychological deficits. Six of the nine patients showed behavioural disinhibition, and mood changes were also observed. Memory impairment in HZE was not as global or as severe as is described after encephalitis due to herpes simplex virus. In HZE both the brain perfusion pattern and the neuropsychological test profile showed features compatible with subcortical dysfunction.

Adult↗
PubMed1997

Epidemiology of encephalitis in children. A prospective multicentre study.

UNLABELLED: We found 175 cases with acute encephalitis in a population of 791,712 children aged 1 month-15 years during a 2-year surveillance period in 1993-1994. The overall incidence was 10.5/100,000 child-years with the highest figure in children < 1 year of age, 18.4/100,000 child-years. The microbial diagnosis was considered proven or suggested in 110 cases (63%); varicella zoster, respiratory and enteroviruses comprised 61% of these, and adeno, Epstein Barr-, herpes simplex and rota viruses comprised 5% each. A clearcut change seems to have occurred in the aetiology of encephalitis. Mumps, measles, and rubella virus associated encephalitides have been almost eliminated. Varicella zoster, respiratory, and enteroviruses have increased in frequency and occur in younger age groups. New causes were identified, especially Chlamydia pneumoniae and HHV-6. Our data should assist in making a specific diagnosis and defining appropriate antimicrobial therapy. CONCLUSIONS: The spectrum of encephalitis in children has changed due to vaccination programs. The incidence, however, appears to be about the same due to increasing frequency of other associated old and new microbes.

Acute Disease↗
PubMed1997

Experimental infection of nude mice as a model for Sarcocystis neurona-associated encephalitis.

The development of a rodent model for the study of Sarcocystis neurona encephalitis is described. Animal models have been developed for a number of protozoal parasites; however, no such model exists for S. neurona. The approach used in this study is similar to that employed for other closely related protozoal parasites such as Neospora caninum and Toxoplasma gondii. A time course of infection was examined, and histopathology, immunohistochemistry, and parasite isolation were used to examine the pathogenesis and follow the infection from 1 to 6 weeks postinoculation. S. neurona was associated with the development of encephalitis in these mice, and the immune status determined the susceptibility of these mice to S. neurona-associated encephalitis.

Animals↗
PubMed2005

Focal paraneoplastic limbic encephalitis presenting as orgasmic epilepsy.

PURPOSE: To report orgasmic epilepsy as a manifestation of paraneoplastic limbic encephalitis in a patient with small cell lung cancer. CASE REPORT: A 57 years-old woman presented with 2 month history of daily spells that consisted of a sudden pleasure provoking feeling described 'like an orgasm' lasting for 30 s to 1 min. She was a heavy smoker and had noted recent weight loss. Bronchial biopsy, following the finding of a right lung mass, confirmed the diagnosis of small cell lung cancer (SCLC). Spells subsided after starting carbamazepine. The lung cancer was treated with chemotherapy and chest radiation therapy resulting in a complete radiologic response. RESULTS: Brain magnetic resonance imaging (MRI) revealed left temporal lobe area of increased signal on T2 and FLAIR sequence. T1-weighted images after contrast administration demonstrated a circumscribed area of enhancement in the left anterior medial temporal lobe. Electroencephalogram (EEG) showed focal left mid-temporal sharp waves and intermittent slowing. Anti-Hu antibodies were detected in her serum supporting a diagnosis of paraneoplastic limbic encephalitis as the cause of her orgasmic epilepsy. The patient has been followed for 2 years after treatment without tumor recurrence or neurological deterioration. CONCLUSION: Orgasmic epilepsy is another mode of presentation of paraneoplastic limbic encephalitis leading to the diagnosis of an occult SCLC. EEG and MRI findings suggest that in this case the seizures originated from the left hemisphere. It is possible that early recognition and treatment of the SCLC will improve the prognosis of this neurologic entity.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

EFA6A-like antibodies in paraneoplastic encephalitis associated with immature ovarian teratoma: a case report.

We describe a 19-year-old patient with paraneoplastic encephalitis associated with immature ovarian teratoma (OT), who presented with psychiatric symptoms, prolonged disturbance of consciousness, refractory status epilepticus, central hypoventilation, and various abnormal involuntary movements. Immunological characterization of the patient's serum and cerebrospinal fluid (CSF) demonstrated the presence of an autoantibody that colocalized with EFA6A, a brain-specific protein involved in the regulation of dendritic development of hippocampal neurons. Despite the severity of the symptoms, the patient showed significant neurological improvement following removal of the tumor and chemotherapy. This case suggests that physicians should rule out an OT in young women with encephalitis who present with the subacute-onset of psychiatric symptoms. Antibodies that colocalize with EFA6A are a valuable marker for early diagnosis of a potentially reversible paraneoplastic encephalitis associated with OT.

Adult↗
PubMed1979

Cytomegalovirus encephalitis associated with thymoma and immunoglobulin deficiency.

The clinical and immunologic findings in an elderly woman with thymoma and immunoglobulin deficiency in whom cytomegalovirus (CMV) encephalitis developed are described. The patient had absent serum immunoglobulins and no circulating immunoglobulin-bearing lymphocytes. Complement receptor-bearing lymphocytes were present in the peripheral blood, and circulating T lymphocyte numbers were within normal limits. She was anergic to a battery of skin test antigens, and her lymphocytes in vitro showed a selective unresponsiveness to CMV antigen while responding normally to phytohemagglutinin and streptokinase. The course of the encephalitis was progressive with quadriplegia, aphasia and coma developing within six months of onset of symptoms. This is the fifth reported case documenting an association between CMV infection and the syndrome of thymoma with immunoglobulin deficiency, but the first report of fatal CMV encephalitis in a patient with thymoma and immunoglobulin deficiency.

Agammaglobulinemia↗
PubMed1993

Randomized trial of dapsone and aerosolized pentamidine for the prophylaxis of Pneumocystis carinii pneumonia and toxoplasmic encephalitis.

PURPOSE: Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis are the most frequent pulmonary and central nervous system opportunistic infections associated with human immunodeficiency virus (HIV) infection. We designed a prospective study to compare the effects of aerosolized pentamidine and dapsone in the prophylaxis of these infections in HIV-infected persons with CD4+ lymphocyte counts less than 250/mm3. PATIENTS AND METHODS: Two hundred seventy-eight patients seropositive for HIV who had acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex were randomly assigned to receive intermittent dapsone (100 mg twice weekly) or aerosolized pentamidine (100 mg every 2 weeks). The proportion of patients remaining free of PCP or toxoplasmosis was analyzed with the log-rank test as a function of time, as were the effects of zidovudine or prophylaxis on survival. RESULTS: Dapsone and aerosolized pentamidine demonstrated similar efficacy in the primary and secondary prophylaxis of PCP, with 15 (18%) failures among patients receiving dapsone compared to 15 (14%) among those receiving aerosolized pentamidine (p = 0.4), after a mean length of follow-up of 42 and 44 weeks, respectively. Dapsone was more effective in the primary prophylaxis of toxoplasmic encephalitis, with six toxoplasmic encephalitis events occurring among those receiving aerosolized pentamidine, compared to none among those taking dapsone (p = 0.01). Primary prophylaxis for PCP was more effective than secondary prophylaxis with either therapy. Zidovudine therapy did not prevent PCP yet prolonged the PCP-free interval for those in whom either prophylactic therapy failed. Kaplan-Meier estimates did not show a difference in survival between the patients receiving either therapy, yet zidovudine use was associated with improved survival, independent of race and risk factor (Cox proportional hazards model, p = 0.001). The 1-month survival for patients developing PCP despite prophylaxis was better with those in whom dapsone failed than it was for those in whom aerosolized pentamidine failed (p = 0.08). CONCLUSION: Dapsone is as effective as aerosolized pentamidine in preventing PCP and has the advantage of a lower cost, easier administration, and possibly an additional preventive effect against toxoplasmosis. Zidovudine prolongs the PCP-free interval for patients receiving prophylaxis, regardless of which prophylactic agent is used.

AIDS-Related Opportunistic Infections↗
PubMed1994

The development of cytomegalovirus encephalitis in AIDS patients receiving ganciclovir.

PURPOSE: Cytomegalovirus (CMV) retinitis in patients with the acquired immunodeficiency syndrome (AIDS) requires lifelong therapy with either intravenous ganciclovir sodium or foscarnet sodium. From June 1989 through February 1992, seven patients with AIDS were diagnosed to have CMV retinitis, and all were treated with ganciclovir. Five of the seven developed abrupt preterminal mental status changes. All five with mental status changes received anti-CMV therapy until the time of death. Autopsies were performed in all cases to determine the cause of mental status changes. PATIENTS AND METHODS: Five patients with AIDS and newly diagnosed CMV retinitis. Retrospective case analyses with autopsies. All five patients were treated with gangciclovir immediately upon the diagnosis of CMV retinitis and received ganciclovir at standard dosages until death. RESULTS: Four patients had clinically stable retinitis throughout the entire course of ganciclovir therapy. In the fifth patient, because of fundoscopic deterioration, foscarnet therapy was initiated 1 month prior to death. Cerebrospinal fluid analysis and magnetic resonance imaging, although abnormal, were not diagnostically specific. Neuropathologic examination revealed fulminant diffuse CMV encephalitis in all patients, with prominent ependymal and periventricular necrosis. CONCLUSIONS: These results suggest that while ganciclovir therapy may clinically stabilize CMV retinitis in patients with AIDS, it does not appear to prevent the development of, or be effective in the treatment of, CMV encephalitis. Thus, clinicians should consider the diagnosis of CMV encephalitis in patients receiving ganciclovir who develop mental status changes and, if possible, alter therapy accordingly.

AIDS-Related Opportunistic Infections↗
PubMed1976

Herpes encephalitis. Rapid diagnosis and treatment with antiviral drugs.

The use of specific IgM antibodies and direct electron-microscopic examination of brain biopsies or vesicle fluid was tested as means of raped diagnosis in 6 cases of herpes simplex encephalitis seen consecutively in Montreal. In 2 of 3 biopsies herpes viruses were seen by negative staining of a cell extract within 1 hr. In the negative case, the biopsy was done almost 1 month after onset. In 2 additional cases herpes virus particles were found directly in the fluid of isolated vesicles. In the last 2 cases, who survived, the diagnosis of herpes encephalitis rested upon the demonstration of a greater than 4-fold rise in complement fixing herpes simplex virus antibodies in convalescent sera and upon the appearance late in the course of the encephalitis of specific antibodies in the cerebrospinal fluid. The early appearance of specific IgM antibodies contributed to the diagnosis in 4 of the 6 cases. Antiviral therapy was attempted in alternate cases (3 cases) but was not successful. Brain biopsy is rarely performed for diagnostic purposes but when prompt antiviral therapy is contemplated, the examination of the biopsy material for herpes virus particles by electron microscopy in negative staining and thin sections can rapidly and reliably confirm the diagnosis.

Aged↗
PubMed1982

Distribution of measles antigen and immunoglobulin-containing cells in the CNS in subacute sclerosing panencephalitis (SSPE) and atypical measles encephalitis.

The immunoperoxidase technique has been used to study the distribution of measles virus antigen and immunoglobulin (Ig)-containing cells within the CNS, in 5 cases of subacute sclerosing panencephalitis (SSPE) and 1 case of atypical measles encephalitis. Measles virus antigen was demonstrated within the brain in all cases, and in the spinal cord in 1 case of SSPE. Ig-containing cells were also demonstrated in all cases, the proportions of the different light and heavy chain types varying somewhat from case to case. In SSPE IgG constituted the major and IgA the principal minor heavy chain demonstrated. In all cases of SSPE there was significant excess of light-chain-containing over heavy-chain-containing cells. In the case of atypical measles encephalitis there was a paucity of Ig-containing cells and a relatively high proportion (39%) of these contained IgM. The case of atypical measles encephalitis differed from those of SSPE also in the presence of multinucleate giant cells, some of which contained measles virus antigen.

Adolescent↗
PubMed1995

Affinity of antigen-specific IgG distinguishes multiple sclerosis from encephalitis.

The characteristics of antigen-specific IgG in patients with multiple sclerosis and patients with encephalitis have been compared. Both groups of patients showed antigen-specific oligoclonal bands locally synthesised in the CSF. When the affinity distribution of the antigen-specific IgG was measured there was a marked difference between the two groups. Encephalitis patients had high affinity antibody against the causative antigen. This was consistent with the antibody undergoing affinity maturation as a result of the immune system fighting a primary infection. Multiple sclerosis patients lacked high affinity response. This lack of high affinity antibody was also seen in those encephalitis patients when antigens other than the causative antigen were studied.

Adolescent↗
PubMed1995

The virus causing encephalomyelitis in sheep in Spain: a new member of the tick-borne encephalitis group.

The nucleotide and deduced primary amino acid sequence of the envelope gene of two virus isolates from the brains of Spanish sheep with encephalomyelitis, were determined and compared with those of other flaviviruses. The amino acid alignments showed that the Spanish viruses shared 95 to 96 per cent homology with the envelope protein of louping ill virus and western European tick-borne encephalitis virus. In comparison, the maximum variation in amino acid identities among strains of louping ill virus from the British Isles is 1.8 per cent. The Spanish isolates were distinguishable from all other known flaviviruses by the presence of a unique tripeptide sequence (AQR) at amino acid positions 232 to 234 in the E protein, the position at which a genetic marker for distinct flavivirus species has been identified. Other genetic markers, viz DSGHD (amino acids 320 to 324) and EHLPTA (amino acids 207 to 212), which identify the tick-borne encephalitis group within the genus Flavivirus, were present in the amino acid sequences of the Spanish virus. It is concluded that the cause of sheep encephalomyelitis in Spain is a distinct species in the tick-borne encephalitis virus group.

Animals↗
PubMedDate not supplied

Arboviruses as aetiological agents of encephalitis in the People's Republic of China.

A serological study was undertaken to determine the role of arboviruses as etiological agents of encephalitis in the People's Republic of China (PRC). Paired sera were collected during mosquito seasons in 1988-1990 from 614 patients with possible viral encephalitis in 15 regions of PRC and tested for haemagglutination inhibiting antibodies to selected arboviruses. Seroconversions were documented to alphavirus and flavivirus antigens in 13.0 and 18.7% of patients respectively in most of the study areas. No California group seroconversion was detected. The age of alphavirus seroconvertors ranged from 2 months to 32 years and of flavivirus seroconvertors from 6 months to 50 years, with higher numbers in males. Serious central nervous system manifestations were seen more commonly in flavivirus seroconvertors. This study affirms the importance of flavivirus as causative agents of encephalitis in PRC and provides evidence that one or more alphaviruses are causing symptomatic infections with neurological involvement in PRC.

Adolescent↗
PubMed1988

Clinical course of subacute HIV encephalitis.

A subacute encephalitis is increasingly recognized to be the most frequent cerebral manifestation of human immunodeficiency virus (HIV) infection. Contradictory reports are given in the literature concerning its clinical course. In the present study, a group of 19 patients with subacute encephalitis was followed for an average of 210 days. A steady progression of the disease was documented using the Karnofsky index. An advanced disease, rated according to the Walther Reed staging classification, but not isolated immunological parameters such as the ratio of OKT4/8 subsets are associated with more rapid progression of the encephalitis. Age, social status, duration of HIV positivity and antibody titers to cytomegalovirus could not be identified as contributing factors.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Toxoplasma encephalitis of immunocompetent and nude mice: immunohistochemical characterisation of Toxoplasma antigen, infiltrates and major histocompatibility complex gene products.

The experimental infection of immunocompetent and immunodeficient athymic mice with an avirulent encephalitogenic Toxoplasma strain (DX strain) was employed to study the ensuing encephalitic process by use of histological and immunocytochemical methods. In the acute phase of the infection Toxoplasma cysts and tachyzoites were accompanied by an infiltrate composed of macrophages, CD4+ and CD8+ T cells. In the chronic stage a granulomatous encephalitis developed. In contrast to immunocompetent NMRI mice, athymic nude NMRI mice died 3 weeks post-infection because of a generalized toxoplasmosis with predominant involvement of the brain. A salient feature of murine Toxoplasma encephalitis was up-regulation of class I and II major histocompatibility complex (MHC) gene products. Class I antigen was widely expressed on microglial cells and astrocytes. Class II antigen was only expressed on microglial cells despite a considerable astrogliosis. Our results indicate a differential expression of MHC-determined antigens on brain cells in acute and chronic murine Toxoplasma encephalitis.

Animals↗
PubMedDate not supplied

Electroencephalogram and evoked potentials in the primate model of viral encephalitis.

Squirrel monkeys with induced canine distemper virus (CDV) encephalitis showed characteristic clinical signs such as seizures or myoclonus, with EEGs showing periodic synchronized discharge (PSD). Histopathologically, there was gliosis and neuronal degeneration diffusely distributed in both the gray and white matters in the subacute phase, the lesions resembling those found in childhood acute viral encephalitis and subacute sclerosing panencephalitis (SSPE). The auditory brain-stem response (ABR) changes were remarkable in the subacute phase, and the recovery of latency was correlated with survival. The visual evoked potential (VEP) abnormalities disappeared in the acute phase and appeared again with delayed latency in the subacute stage. One monkey which did not show clinical signs but had the pathological changes showed the VEP abnormality. These data suggest that the evoked potentials are helpful in judging the prognosis, and that this model is useful for the analysis of the pathogenesis of viral encephalitis.

Animals↗
PubMed1983

Clonal expansion and functional analysis of virus-specific T lymphocytes from cerebrospinal fluid in measles encephalitis.

T cells were directly cloned from the cerebrospinal fluid (CSF) of a patient with acute measles encephalitis by limiting dilution in the presence of irradiated feeder cells and T cell growth factor (TCGF). A total of 42 colonies was established. Functional analysis revealed 27 of them to be derived from a cytotoxic T lymphocyte as demonstrated by the ability to exert phytohaemagglutinin (PHA)-dependent cytotoxicity against uninfected allogeneic PHA blasts. Twenty-three of the cytotoxic colonies were specific for measles virus and restricted to self HLA-A or -B antigens. Three clones were also found to give measles virus-specific proliferative responses. The results show that the CSF in measles encephalitis contains a highly enriched population of in vivo sensitized antigen-specific T cells. We propose that the clinical symptoms in measles encephalitis are caused by a T cell-mediated reaction against virus-infected brain cells.

Child↗
PubMed1993

Herpes simplex encephalitis mimicking mumps.

A 16-year-old male diabetic patient presented with bilateral salivary gland swellings followed by encephalitis. The EEG did not show the characteristic periodic lateralising epileptic discharges. Neuro-imaging disclosed compromise of temporal and frontal lobes as well as brain stem which correlated well with his clinical deterioration. Serology and frontal brain biopsy were positive for herpes simplex virus while mumps titers were not significant. Despite delayed acyclovir therapy, the patient recovered enough to be discharged home with a permanent pseudobulbar palsy. Herpes simplex encephalitis involving zones other than temporal lobes is exceptional. To our knowledge, there are no reported cases of pseudobulbar palsy as a sequelae of HSV encephalitis.

Acyclovir↗