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At least 955 records · Page 53Linked to original sources
PubMed2001

Crossed cerebellar diaschisis in herpes simplex encephalitis.

Diaschisis is extremely rare in patients with viral encephalitis. We report the phenomenon of crossed cerebellar diaschisis (CCD) in a 73-year-old man with acute herpes simplex type-1 (HSV-1) encephalitis. The diagnosis of HSV-1 encephalitis was confirmed by detecting HSV-1 deoxyribonucleic acid in the cerebrospinal fluid (CSF). Magnetic resonance images (MRI) showed enhancing lesions at bilateral temporal lobes, insular cortices, and right frontoparietal lobes. Increase signal intensity on T2-weighted images was seen in the mesecephalon. Technetium-99m ethyl cysteinate dimer (99mTc-ECD) single photon emission computed tomography (SPECT) of the brain showed a large area of hypoperfusion in the right frontotemporoparietal lobes. The side-to-side cerebellar count revealed 19% reduction of the radioisotope tracer uptake in the left cerebellum. The phenomenon of CCD was proposed to be due to both anterograde disconnection of the corticopontocerebellar tracts and retrograde deafferentation of dentatothalamocortical projections.

Brain↗
PubMed2002

Meningitis and encephalitis in children. An update.

Over the course of the past decade, much has changed on the landscape of meningitis and encephalitis in children. West Nile virus has emerged in the United States as a new etiologic pathogen causing encephalitis. Human herpesvirus-6 has been identified as a cause of encephalitis and febrile seizures. Lymphocytic choriomeningitis virus has been identified as an underrecognized neuroteratogen. The emergence of penicillin-resistant Streptococcus pneumoniae has complicated the treatment of bacterial meningitis, whereas the Haemophilus influenzae vaccine has fundamentally altered the disease's epidemiology. The recognition that much of the neuropathologic change induced by bacterial meningitis is inflammation mediated has paved the way to the demonstration that dexamethasone can substantially improve the outcome of bacterial meningitis in children. Although much progress has been made toward understanding, treating, and preventing these important infections, much remains to be learned.

Anti-Inflammatory Agents↗
PubMed1999

Encephalitis.

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

Brain↗
PubMed1985

[Postoperative herpetic encephalitis. Value of Klapper's diagnostic method].

A case of a 51 year old female with herpes encephalitis is reported. She underwent surgery for chronic pancreatitis with pseudocyst formation. On the third postoperative day, she developed a severe vesicular nasolabial eruption associated with a deep stupor. Anti-Herpes simplex viral (HSV) antibodies were found in both blood and cerebrospinal fluid. Klapper's anti-HSV antibody ratio was calculated and agreed with the hypothesis of herpes encephalitis. The patient was given nucleoside analogues. She rapidly improved and was discharged from the intensive care unit without any sequelae. The frequency of HSV infection in intensive care patients and the use of Klapper's index for the diagnosis of herpes encephalitis in these patients are then discussed.

Antibodies, Viral↗
PubMed2003

Herpes simplex encephalitis and radiotherapy.

The pathogenesis underlying the reactivation of latent herpes simplex virus remains undefined. This article presents the case of a 15-year-old male who developed herpes simplex encephalitis, as proven by a positive cerebrospinal fluid polymerase chain reaction and supported by magnetic resonance imaging findings during radiotherapy for pontine glioma. The temporal relation of radiotherapy to the occurrence of herpes simplex encephalitis suggests that cranial irradiation may play a role in the reactivation of latent herpes simplex virus. This finding suggests that herpes simplex encephalitis should be a part of the differential diagnosis of acute neurologic decline in patients undergoing cranial radiotherapy.

Adolescent↗
PubMed1999

Influenza A encephalitis with movement disorder.

Influenza A is an uncommon but well-recognized cause of viral encephalitis in childhood, occurring most commonly during community influenza outbreaks. The authors report four cases of influenza A encephalitis that occurred during an Australian epidemic in 1997-1998. Choreoathetosis during the acute phase of infection or basal ganglia involvement on neuroimaging was observed in three of the four patients. These findings in pediatric encephalitis are suggestive of influenza A infection and may guide investigation and early diagnosis.

Basal Ganglia↗
PubMed1999

Bilateral hippocampal encephalitis caused by enteroviral infection.

Nonpolio enteroviral encephalitis usually presents as a diffuse, generalized encephalitis. Focal cerebral involvement by nonpolioviruses is uncommon, and neuroradiologic studies in these cases are usually normal. The authors present a case of a 5-year-old male with an acute encephalitic illness and bilateral lesions of the hippocampi on magnetic resonance imaging. Enteroviral nucleic acids were detected in the cerebrospinal fluid by the reverse transcription polymerase chain reaction. The findings suggest that enteroviral infection should be considered in the differential diagnosis of acute bilateral hippocampal encephalitis in patients in whom polymerase chain reaction fails to demonstrate the presence of herpes simplex virus.

Child, Preschool↗
PubMed1998

California-La Crosse encephalitis.

La Crosse encephalitis, a mosquito-borne viral disease that can be mistaken for herpes simplex encephalitis, is under-recognized in the United States, despite case reports from 28 states and an incidence in endemic areas (20-30/100,000) exceeding that of bacterial meningitis. The disease recurs every summer in endemic foci in the midwestern and mid-Atlantic United States in areas forested with hardwood trees, which provide breeding sites for the treehole-dwelling mosquito vector, Aedes triseriatus. La Crosse encephalitis should be considered in the child presenting with meningoencephalitis in summer and early fall, particularly for children living in (or recent travel to) endemic areas in mid-Atlantic and midwestern states.

Aedes↗
PubMedDate not supplied

Herpes simplex encephalitis: diffusion MR imaging findings.

We studied five patients with herpes simplex encephalitis type 1 with diffusion-weighted MR imaging, as this sequence provides information regarding tissue integrity. Diffusion-weighted imaging was obtained using the echo-planar sequence. True diffusion images (i.e. b=1000s/mm(2) images), and the ADC (apparent diffusion coefficient) values were studied. In addition, diffusion imaging of 12 normal cases, 46 patients with acute ischemia (cytotoxic edema), and 12 patients with vasogenic edema were studied for comparison. In patients with herpes encephalitis, two distinct types of diffusion imaging findings (on b=1000s/mm(2) images, and ADC maps) were noted: lesions similar to cytotoxic edema, and lesions similar to vasogenic edema. The patients with the former type of lesions had fulminating disease, and were in severe clinical condition. Those with the latter represented early cases, and they were in fairly good clinical condition with a good outcome by prompt therapy. Diffusion imaging appears to be a promising sequence to monitor the changes in the brain tissue in herpes encephalitis, and in other infections as well with respect to restriction of movement (cytotoxic edema) or relatively high-motion (vasogenic edema) of water molecules, providing data on the severity of the disease.

Adolescent↗
PubMedDate not supplied

Paraneoplastic limbic encephalitis: case report.

Paraneoplastic limbic encephalitis, which is also known as the remote neurological effect of cancer, is a rare neurological paraneoplastic disorder that usually presents with changes in mental status and behavioral abnormalities. Paraneoplastic limbic encephalitis had been diagnosed by clinical, laboratory and pathological studies in the pre-MRI era, but the diagnosis became much easier with MRI. We present MRI pictures of a case of paraneoplastic limbic encephalitis associated with small cell carcinoma of the lung.

Carcinoma, Small Cell↗
PubMed1998

Acute encephalitis in Swiss children: aetiology and outcome.

Since published data on the course and prognosis of encephalitis in Central Europe is limited, we retrospectively evaluated 104 children with either acute strict sense encephalitis (n = 80) or acute cerebellar ataxia (n = 24) treated at the Department of Pediatrics, University of Bern, Switzerland, between 1980 and 1991. Of the 80 patients with strict sense encephalitis, four (5%) died acutely and 28 (36%) of 78 followed up had sequelae - eight patients with severe, six with moderate and 14 with mild sequelae. Young age and seizures were shown to correlate with poor outcome. Among the 24 patients with acute cerebellar ataxia, there was no fatal outcome and none developed severe residua, but six had mild and one had moderate sequelae. Initial cerebrospinal fluid white cell count was significantly higher in these children with sequelae compared with those without any sequelae after acute cerebellar ataxia.

Acute Disease↗
PubMed2000

Virological diagnosis of herpes simplex encephalitis.

BACKGROUND: The herpes simplex encephalitis (HSE) represents one of the most severe infectious diseases of the central nervous system. As effective antiviral drugs are available, rapid and reliable diagnosis has become important. OBJECTIVES: To evaluate retrospectively the usefulness of polymerase chain reaction (PCR) as well as serological procedures for the diagnosis of HSE. STUDY DESIGN: 631 cerebrospinal fluids (CSF) from patients with clinical suspicion of encephalitis were tested for type-specific herpes simplex virus (HSV) DNA using PCR. Virus-specific antibodies including their intrathecal synthesis were measured in 624 CSF and 2409 serum samples of 2711 patients suspected of having encephalitis. RESULTS: Positive results were obtained by PCR in eight patients (1. 3%) for HSV-1 and in seven (1.1%) for HSV-2. Intrathecal antibody synthesis was estimated in 24 (3.8%) patients. In general, no intrathecal antibodies could be measured in patients with positive PCR results and vice versa the intrathecal immune response became positive when CSF was cleared from the HSV. Results of the antibody detection in serum specimens revealed an active HSV infection in 268 out of 2367 patients (11.3%). CONCLUSIONS: The detection of HSV-DNA by PCR is the method of choice for diagnosis of HSE in the early phase of the disease. During the later stage, it has to be diagnosed by the estimation of intrathecally synthesized antibodies.

Adolescent↗
PubMed1973

California encephalitis virus endemicity in the Yukon Territory, 1972.

Sera from 218 of 1574 (14%) small mammals collected in the Yukon Territory between 14 May and 13 August 1972 neutralized a Yukon strain of California encephalitis virus (snowshoe-hare subtype). These included 133 of 319 (42%) snowshoe hares (Lepus americanus), 84 of 1243 (7%) ground squirrels (Citellus undulatus) and 1 of 12 (8%) tree squirrels (Tamiasciurus hudsonicus). California encephalitis virus (snow-shoe hare subtype) was isolated from four pools of unengorged Aedes communis mosquitoes collected near Whitehorse (61 degrees N., 135 degrees W.) and on one occasion each from pools of the same species collected at Hunker Creek (64 degrees N., 138 degrees W.) and at mile 125, Dempster Highway (66 degrees N., 138 degrees W.) during July 1972. Replication of a Yukon strain of California encephalitis virus was observed in wild-caught Culiseta inornata and Aedes canadensis mosquitoes after intrathoracic injection and holding at temperatures of 80 degrees , 50 degrees and 40 degrees F.

Animals↗
PubMed2006

Utility of Ictal SPECT in the presurgical evaluation of Rasmussen's encephalitis.

BACKGROUND: Rasmussen's encephalitis is a progressive disease characterized by severe progressive neurological and cognitive deficits. It is a difficult condition to treat with conventional medical treatment and requires, in most of the cases, surgical intervention. METHODS: We present the case of a patient with Rasmussen's encephalitis who presented with epilepsia partialis continua, who did not respond to antiepileptic treatment and was evaluated for possible surgical intervention. RESULTS: The electroencephalographic studies revealed bihemispheric involvement during seizures, although magnetic resonance imaging (MRI) showed a marked right hemispheric atrophy. Hyperperfusion over the right hemisphere was seen with the performance of ictal single photon emission computed tomography (SPECT), which finally guided a right functional hemispherectomy and subsequent seizure control. CONCLUSION: Ictal SPECT could be a useful tool in the armamentarium of tools used for the localization of the epileptogenic focus in patients with Rasmussen's encephalitis and other localization-related epilepsies.

Adult↗
PubMed2006

Rasmussen's encephalitis in a 58-year-old female: still a variant?

BACKGROUND: We report the case of a 58-year-old female with clinical, radiological, and histopathological evidence of Rasmussen's encephalitis, representing the oldest confirmed case to date. CASE SUMMARY: The patient presented with complex partial seizures characterized by numbness of the left face and staring spells. These progressed to a state of epilepsia partialis continua with jerking of the left face, as well as severe cognitive impairment and loss of all communication. The patient responded well to Intravenous Immunoglobulin (IVIG) therapy despite early complications and with ongoing treatment is living independently with minimal cognitive impairment. CONCLUSIONS: This represents the oldest confirmed case of Rasmussen's encephalitis and suggests that this diagnosis should be considered in patients of any age with an appropriate clinical picture. We recommend IVIG as a first line therapy for adult cases of Rasmussen's encephalitis.

Adolescent↗
PubMed1996

Paraneoplastic limbic encephalitis in Hodgkin's disease.

BACKGROUND: Oat cell carcinoma of the lung is the most common cause of paraneoplastic limbic encephalitis. Association with other malignancies, in particular Hodgkin's disease, is very rare. CASE REPORT: This 23-year-old male presented with a six month history of progressive alteration in mental status, which consisted of insomnia, short-term memory loss, depression and cognitive impairment. Gadolinium MRI of the head showed intense bilateral contrast enhancement affecting the medial aspects of the temporal lobes in the region of the amygdala and hippocampus. The brain biopsy showed minimal neuronal loss with intense perivascular lymphocytic cuffing and microglial nodules. Polymerase chain reaction for herpes simplex and cytomegalovirus were negative. With prednisone treatment, the patient's neurologic status stabilized but did not improve. Four months later, he presented with left axillary lymphadenopathy. Lymph node biopsy was diagnostic of Hodgkin's disease. During the chemotherapy, his lymphadenopathy subsided and his neurologic and mental status improved. When seen last after completion of his chemotherapy, one year after presentation, he had resumed normal social activities and was enrolled in a university language course. CONCLUSION: This is the first reported case in the English literature of a biopsy proven paraneoplastic limbic encephalitis associated with Hodgkin's disease. Hodgkin's disease should be thought of as a possible cause of paraneoplastic limbic encephalitis in the appropriate clinical setting.

Adult↗
PubMed1995

Sudden 'stroke-like' onset of hemiparesis due to herpetic encephalitis.

BACKGROUND/OBJECTIVE: Herpes simplex encephalitis usually has a progressive cause. Sudden neurological deficits are unusual. METHOD: Case study. RESULTS: A 17-year-old girl presented with an acute onset focal neurological deficit followed one week later by the more classical feature of altered level of consciousness, fever and focal seizures. The diagnosis of herpetic encephalitis was made by magnetic resonance imaging (MRI) and by the significant increase in cerebrospinal fluid titres of antibodies against herpes simplex type I. CONCLUSION: Herpetic encephalitis should be considered in the differential diagnosis of acute stroke in young patients even in the absence of encephalitic features, if common etiological factors such as embolization and intracerebral bleed are excluded.

Adolescent↗
PubMed1993

Weather factors in the prediction of western equine encephalitis epidemics in Manitoba.

Cases of western equine encephalitis in horses in 1987 in western USA and Manitoba, Canada were examined by backward trajectory analysis of winds. Culex tarsalis mosquitoes infected with western equine encephalitis virus could have been carried on southerly winds from Texas and Oklahoma to northern USA and from there to Manitoba. The presence of the Polar front over North Dakota and Minnesota at the end of July would have led to the landing of Cx. tarsalis in Montana and Wisconsin and prevented further carriage into Manitoba. Temperatures in southern Texas during the winter months (average daily maximum temperatures 19.7 degrees C and higher) would have permitted continuous transmission of western equine encephalitis virus by Cx. tarsalis in this area. Weather factors involved in outbreaks from 1975-88 were analysed to see if epidemics in Manitoba (23 or more cases in horses) could be predicted. The conditions for epidemics could be defined as follows: (a) the number of cases in horses in USA was 98 or more, (b) winds were southerly with speeds 45 kmh-1 or higher, and (c) counts of Cx. tarsalis females/light trap per day were 3.2 or higher. There were 3 or fewer cases in Manitoba, when the number of cases in USA was 27 or less, even when Cx. tarsalis counts were higher than 3.2. With Cx. tarsalis counts below 3 and/or unsuitable winds, or the Polar front further south, the number of cases in Manitoba was between 0 and 17, even when the number of cases in USA was from 38-172. Without information on the extent of infection further south, the weather variables would probably be more useful in excluding the possibility of an epidemic in Manitoba than in predicting one.

Animals↗