1/106. adult-onset MELAS presenting as herpes encephalitis.OBJECTIVE: To report an unusual presentation of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) manifested in late life with a clinical picture of herpes simplex encephalitis. DESIGN: Case report. SETTING: Clinical neurology department in a tertiary care hospital. CASE DESCRIPTION: A 55-year-old woman developed aphasia and delirium during ophthalmic herpes zoster infection treated with oral prednisone and ophthalmic steroids, which was followed by progressive cognitive decline without acute neurologic events for 5 years. At age 60, the patient presented with new onset of seizures, hemiparesis, and hemianopsia. Subsequently she developed cortical blindness, multiple traumatic soft tissue injuries from falls, acute psychosis, and severe dementia with periods of agitation. She died in a nursing home in March 1997, 6 years after initial presentation. RESULTS: magnetic resonance imaging scan of the brain showed hyperintensity on T2-weighted images involving temporal, parietal, and occipital lobes bilaterally as well as mild atrophy of brainstem and cerebellum. Single photon emission computed tomographic imaging showed hypoperfusion of temporal, parietal, and occipital lobes. Results of video electroencephalographic monitoring showed periodic lateralizing epileptiform discharges in temporal and occipital areas. The serum lactate level was normal in May 1996 and elevated in October 1996. The creatine kinase level was elevated with a 100% MM fraction in August 1991 and normal in March 1996. Results of repeated cerebrospinal fluid analyses indicated elevated protein levels. Analysis of dna was diagnostic of MELAS by mitochondrial dna point mutation at position 3243. The results of autopsy showed moderate cerebral, cerebellar, and brainstem atrophy with signs of infarction in temporal and parietal lobes bilaterally. CONCLUSIONS: The clinical presentation as well as age at onset of MELAS are highly variable. Onset of mitochondrial disorders can be provoked by febrile illness when there is mismatch between energy requirements and availability. In the differential diagnosis of herpes encephalitides, melas syndrome should be considered.- - - - - - - - - - ranking = 1keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
2/106. Reactivation of herpes virus after surgery for epilepsy in a pediatric patient with mesial temporal sclerosis: case report.OBJECTIVE: This case report is presented to raise the awareness of the potential risk of reactivation of herpes simplex virus (HSV) encephalitis after intracranial surgery. CLINICAL PRESENTATION: The case of an 8-year-old male patient who suffered a reactivation of HSV encephalitis after undergoing amygdalohippocampectomy for complex partial seizures is reported. This patient had previously contracted HSV 1 meningoencephalitis at the age of 16 months. Six years later, a left amygdalohippocampectomy was proposed after the development of intractable partial epilepsy associated with left mesial temporal lesions. During the postoperative period, the patient suffered severe clinical deterioration with partial status epilepticus, aphasia, and hyperthermia, which resolved after intensive antiepileptic treatment supported by acyclovir. CONCLUSION: We advise prophylactic pre-, peri-, and postoperative treatment with acyclovir for patients with known histories of HSV encephalitis who undergo intracranial procedures.- - - - - - - - - - ranking = 0.9075662197258keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
3/106. Atypical herpes simplex encephalitis presenting as operculum syndrome.This case report demonstrates the course of herpes simplex virus cerebritis in a patient aged 7 years 2 months who presented with non-specific symptoms followed by an epileptic attack. Subcortical, bilateral opercular and bilateral thalamic lesions were detected, but the temporal and inferior frontal lobes were spared. The patient developed anarthria, impairment of mastication and swallowing consistent with operculum syndrome. diagnosis was made by magnetic resonance imaging and elevation of oligoclonal antibodies specific to herpes simplex virus in cerebrospinal fluid after an unexpectedly negative polymerase chain reaction test.- - - - - - - - - - ranking = 4.3361919550644keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
4/106. Diaschisis in chronic viral encephalitis with Koshevnikov syndrome.The authors report a 61-year-old man with chronic viral encephalitis and Koshevnikov syndrome occurring 42 months after initial symptom of right hemiparesis. Serial computed tomography of the brain showed changes in the attenuation of the left temporal lobe lesion over time. Magnetic resonance images of the brain showed enlargement of left temporoparietooccipital lobes with cortical gyral enhancement on T1-weighted images following intravenous administration of gadolinium-DTPA. 99mTc-HMPAO single-photon emission computerized tomography showed increased radioactivity and hyperperfusion in the left temporoparietal region with paradoxically decreased local tissue perfusion at the contralateral right hemisphere. Follow-up magnetic resonance images of the brain 4 years later showed atrophy of bilateral cerebral hemispheres. We postulate that a "transcallosal diaschisis" with subsequent degeneration is a possible mechanism. A brain biopsy from the left temporal lobe lesion showed pictures compatible with viral encephalitis probably herpes simplex encephalitis.- - - - - - - - - - ranking = 0.7226986591774keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
5/106. Operative treatment of tentorial herniation in herpes encephalitis.herpes simplex virus is the most common cause of acute viral encephalitis in children. Due to the variety of possible clinical manifestations the diagnosis is often overlooked in the early stages of the disease. Anti-viral therapy with acyclovir should be started whenever HSE is suspected. When there is further deterioration under virostatic therapy, a brain biopsy should be performed to verify the diagnosis. But even when the adequate medical therapy is established, massive brain edema and brain shift resulting in tentorial herniation can develop. Up to now the reported mortality of these patients is still around 30%. Here we report on a child with severe necrotizing herpes simplex encephalitis who developed severe tentorial herniation due to a right-sided mass lesion. The patient's status markedly improved after decompressive anterior temporal lobe resection. To our knowledge a similar case has not yet been reported in the literature. We suggest that anterior temporal lobe resection and decompressive craniotomy is of benefit in selected cases with tentorial herniation because both decompression and reduction of infectious material can be achieved.- - - - - - - - - - ranking = 1.0077455500746keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
6/106. Temporally-specific retrograde amnesia in two cases of discrete bilateral hippocampal pathology.The role of the hippocampus in retrograde amnesia remains controversial and poorly understood. Two cases are reported of discrete bilateral hippocampal damage, one of which was a rare case of limbic encephalitis secondary to the human herpes virus 6. Detailed memory testing showed marked anterograde memory impairment, but only mild, temporally-limited retrograde amnesia that covered a period of several years in both autobiographical and factual knowledge domains. The absence of extensive retrograde amnesia in these two cases points to a time-limited role for the hippocampus in the retrieval of retrograde memories, and suggests that entorhinal, perirhinal, parahippocampal, or neocortical areas of the temporal lobe may be more critical than the hippocampus proper for long-term retrograde memory functioning. Our findings offer general support to theories of memory consolidation that propose a gradual transfer of memory from hippocampal to neocortical dependency.- - - - - - - - - - ranking = 0.0462168901371keywords = herpes (Clic here for more details about this article) |
7/106. rothmund-thomson syndrome with herpes encephalitis.A 4-year-old Japanese boy with rothmund-thomson syndrome suffered from severe herpes encephalitis at 5 months of age. The serum level of immunoglobulin g was low and the responsiveness of peripheral blood mononuclear cells to bacterial superantigens was poor. It was suggested that these immunological abnormalities, possibly associated with rothmund-thomson syndrome, led to severe infection with herpes simplex virus in our patient.- - - - - - - - - - ranking = 0.9537831098629keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
8/106. Sudden unexpected death associated with HHV-6 in an adolescent with tuberous sclerosis.A 14-year-old female with tuberous sclerosis and history of seizures was found dead in bed at home 3 days after she had been assessed as doing well at a routine neurology clinic appointment. She had been treated with an antiepileptic drug, felbamate, for 36 months and had been seizure-free except for one seizure episode 5 months before death. Postmortem examination revealed cerebral edema, with uncal and tonsillar herniation, and pulmonary edema, consistent with seizure-induced apnea. Multiple microglial nodules with mature perivascular lymphocytic cuffing and diffuse infiltrates were identified around subependymal tuberous sclerosis giant cell nodules. Immunostaining and electron microscopy revealed human herpesvirus-6-infected macrophages, astrocytes, lymphocytes, and endothelial cells in the subependymal tuberous sclerosis lesions and choroid plexus. Subacute human herpesvirus-6 encephalitis is postulated to have precipitated a seizure and thus sudden unexpected death in epilepsy in this otherwise stable adolescent patient.- - - - - - - - - - ranking = 0.0924337802742keywords = herpes (Clic here for more details about this article) |
9/106. Encephalopathy associated with human herpesvirus 6 in a liver transplant recipient.Recent reports have documented human herpesvirus 6 (HHV-6) as a cause of high fever, bone marrow depression, and rash in liver transplant recipients in the absence of another known pathogen. We describe a 49-year-old liver transplant recipient who developed confusion, occipital headache, and involuntary movements of the limbs 3 weeks after orthotopic liver transplantation. HHV-6 was detected in the peripheral blood using a rapid culture assay. Examination of cerebrospinal fluid by polymerase chain reaction for HHV-6 was also positive. No other pathogens were identified. The patient improved after commencement of intravenous ganciclovir therapy. This case suggests HHV-6 needs to be considered in the differential diagnosis of unexplained confusion in liver transplant recipients.- - - - - - - - - - ranking = 0.2310844506855keywords = herpes (Clic here for more details about this article) |
10/106. Human herpes virus 6 fatal encephalitis in a bone marrow recipient.Human herpes virus 6 (HHV-6) has been implicated as a human pathogen in both normal and immunocompromised hosts. It has been associated with interstitial pneumonitis and bone marrow suppression after transplantation. We report here a case of fatal encephalitis in a bone marrow transplant recipient. This case illustrates the importance of considering HHV6 as an emerging pathogen in immunocompromised hosts.- - - - - - - - - - ranking = 0.2310844506855keywords = herpes (Clic here for more details about this article) |
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