Cases reported "Encephalitis"

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1/5. herpes simplex encephalitis: further evidence for persistent infection in the CNS.

    herpes simplex virus (HSV) antibody titers and IgG, IgM and IgA concentrations in the cerebrospinal fluid were serially measured in a patient with HSV encephalitis during a follow-up period of 32 months. HSV antibody titers, all classes of immunoglobulins and Ig% showed significant elevation during the course of illness, though IgM% and IgA% gradually declined after the acute phase. Autopsied brain tissue failed to yield a virus isolate, but conspicuous perivascular lymphocyte infiltrate, which is compatible with HSV encephalitis, was seen. These observations suggest the occurrence of HSV persistence and persistent antigen stimulation in the central nervous system, analogous to the well-recognized latent condition within the trigeminal ganglion.
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2/5. Chronic intestinal pseudoobstruction as a possible sequel to encephalitis.

    A patient is reported who presented with a typical intestinal pseudoobstruction syndrome. Before this illness, the patient had suffered from measles encephalitis at the age of 15 months. A postencephalitic syndrome was present which included severe mental retardation, parkinsonism, and epilepsy. There were no relatives with a similar disease. Clinically, there was a frank recurrent pseudoobstruction syndrome with occasional diarrhea. Radiographic barium studies showed delayed transit, hypomotility of the intestines, and gross distension of the esophagus, stomach, small intestine, and colon. Histological examination of the gastrointestinal tract revealed a normal appearance of the mucosa; however, there was a hypertrophic muscle layer with abnormalities of the plexuses. Both the submucosal and the myenteric plexuses were reduced in number and size. They showed a decreased number of ganglion cells, proliferation of schwann cells and infiltration by lymphocytes. The abnormalities were most strikingly present in the esophagus and the small intestine. The intestinal neuropathy resulting in clinical pseudoobstruction is proposed to be part of the generalised neurological pathology as a late sequel to the measles encephalitis.
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3/5. Varicella-zoster virus infection of the central nervous system in the acquired immune deficiency syndrome.

    Productive varicella-zoster virus (VZV) infection of the central nervous system (CNS) was demonstrated in 11 acquired immune deficiency syndrome (AIDS) patients using immunocytochemistry and in situ hybridization. A characteristic zoster skin eruption was seen in only four cases. From our own series and 11 other cases in the literature, we identified five clinico-pathological patterns of VZV infection of the CNS in AIDS patients which could occur simultaneously. (i) Multifocal encephalitis predominantly involving the white matter, likely to be due to haematogenous spread of the infection was found in four cases. (ii) Ventriculitis was found in three cases. In two cases there was complete acute or chronic necrosis of the ventricular wall with marked vasculitis; in the third, the ependymal lining appeared irregular with foci of VZV-infected ependymal cells, some of which protruded into the ventricular lumen. (iii) Acute haemorrhagic meningo-myeloradiculitis with necrotizing vasculitis was observed in two cases. In one, this was associated with ventriculitis and was possibly due to shedding of infected ependymal cells into the ventricular lumen and secondary seeding of the CSF. (iv) Focal necrotizing myelitis was seen in one case. It followed cutaneous herpes zoster and was considered to result from neural spread from the diseased dorsal root ganglion similar to cases previously described of encephalitis limited to the visual system following VZV ophthalmicus, or bulbar encephalitis following a trigeminal zoster. (v) Vasculopathy involving leptomeningeal arteries and causing cerebral infarcts was seen in four cases, it was associated with meningitis in most cases. These findings are in keeping with the observation in non-AIDS patients that VZV spread to the CNS may follow different routes. Our study tends to show that VZV infection of the CNS occurs more frequently in AIDS than previously suspected and suggests that it must be considered as a diagnosis in cases of encephalitis, ventriculitis, focal myelitis, acute myeloradiculitis and cerebral infarcts in these patients.
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4/5. Neuroretinitis associated with herpes simplex encephalitis in an adult.

    A 48-year-old man who died of herpes simplex encephalitis had a bilateral papillitis at autopsy. intranuclear inclusion bodies were especially numerous within the ganglion cells and inner nuclear layer of the macula and consisted of typical virions by electron microscopy. Contiguous spread from the brain to the eyes may have occurred via the optic nerves. Clinically, the disk and retinal changes were misinterpreted as being caused by papilledema. Papillitis should be included in the differential diagnosis of disk swelling in adults with suspected Herpesvirus hominis infection of the central nervous system.
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5/5. Aspergilloma in the paracavernous region--two case reports.

    A 30-year-old male and a 40-year-old female presented with aspergillus fungal granuloma in the cerebral locations involving the gasserian-ganglion and its divisions in one case and was densely adherent to the lateral dural wall of the cavernous sinus in the other. Both patients were otherwise healthy with no evidence of immuno-suppression. The lesions resembled benign tumor on preoperative imaging and intraoperative consistency and vascularity. The lesions were successfully and completely resected. Both patients developed major cerebral arterial territory infarcts in the postoperative phase, remote from the site of operation, leading to crippling neurological deficits in one patient and death in the other. The unusual location and the unusual and similar clinical course suggests that awareness of the possibility of ischemic complications after surgical resection of intracranial aspergillomas is necessary.
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