Acute herpes simplex encephalitis (HSE) carries significant morbidity and mortality even after early treatment with antiviral agents (7). As well as causing acute neurological disease, Herpes viruses are associated with relapsing--remitting (Varicella--Zoster, Epstein-Barr) and chronic (Rasmussen encephalitis) disease processes (1). A two-year-old girl developed acute HSE which was followed by a 10-year neurologic illness characterised by asymmetric spastic tetraparesis, pseudobulbar palsy, the opercular syndrome of Foix-Chavany-Marie (4) and seizures. The neurological signs remained static until the child died suddenly 12 years after disease onset. Neuropathologic examination demonstrated active chronic encephalitis. Herpes simplex virus (HSV) DNA was recovered from formalin-fixed paraffin-embedded brain tissue. This case provides additional evidence for the development of chronic neurological disease attributable to persistence of herpes simplex virus type 1.
We describe a 70 year-old-patient with a rare, misleading presentation of lumbar disc prolapse, which on CT mimicked a synovial cyst. The whole nucleus pulposus had herniated, become sequestrated, and migrated behind the theca adjacent to the L4-5 facet joint. There was no continuity of the disc material with the intervertebral space. A fenestration was performed and the sequestrated disc material was found free of adhesions, and removed completely without difficulty. Histopathological examination confirmed the diagnosis. The patient had complete relief from his pain.
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