Diagnostic Clues to Human Herpesvirus 6 Encephalitis and Wernicke Encephalopathy After Pediatric Hematopoietic Cell Transplantation

Sadighi, Zsila; Sabin, Noah D.; Hayden, Randall T.; Stewart, Elizabeth A.; Pillai, Asha

doi:10.1177/0883073814560628

Cited by 20 publications

(17 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other common symptoms reported are hyponatremia, hemophagocytosis, nystagmus, and dysesthesia. Differentiation between HHV-6 encephalitis and Wernicke encephalopathy occurring in pediatric HSCT recipients improves outcome (Sadighi et al 2015 ). In cancer patients, neurologic symptoms usually attributable to brain metastases should be evaluated to exclude a non-oncological cause (Mordenti et al 2013 ).…”

Section: Diagnosismentioning

confidence: 99%

Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals

et al. 2016

View full text Add to dashboard Cite

The roseoloviruses, human herpesvirus (HHV)-6A, HHV-6B, and HHV-7, can cause severe encephalitis or encephalopathy. In immunocompetent children, primary HHV-6B infection is occasionally accompanied by diverse clinical forms of encephalitis. Roseolovirus coinfections with heterologous viruses and delayed primary HHV-7 infection in immunocompetent adults result in very severe neurological and generalized symptoms. Recovery from neurological sequelae is slow and sometimes incomplete. In immunocompromised patients with underlying hematological malignancies and transplantation, frequent single or simultaneous reactivation of roseoloviruses elicit severe, lethal organ dysfunctions, including damages in the limbic system, brain stem, and hippocampus. Most cases have been due to HHV-6B with HHV-6A accounting for 2–3%. The most severe manifestation of HHV-6B reactivation is post-transplantation limbic encephalitis. Seizures, cognitive problems, and abnormal EEG are common. Major risk factors for HHV-6B-associated encephalitis include unrelated cord blood cell transplantation and repeated hematopoietic stem cell transplantation. Rare genetic disorders, male gender, certain HLA constellation, and immune tolerance to replicating HHV-6 in persons carrying chromosomally integrated HHV-6 might also predispose an individual to roseolovirus-associated brain damage. At this time, little is known about the risk factors for HHV-7-associated encephalitis. Intrathecal glial cell destruction due to virus replication, overexpression of proinflammatory cytokines, and viral mimicry of chemokines all contribute to brain dysfunction. High virus load in the cerebrospinal fluid, hippocampal astrogliosis, and viral protein expression in HHV-6B-associated cases and multiple microscopic neuronal degeneration in HHV-7-associated cases are typical laboratory findings. Early empirical therapy with ganciclovir or foscarnet might save the life of a patient with roseolovirus-associated encephalitis.

show abstract

Section: Diagnosismentioning

confidence: 99%

Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In our case report, the patient did not manifest the complete triad, and the most obvious symptoms and signs were mental status changes. The systematic clues to this disease are anorexia, confusion, blindness, amyasthexia, nystagmus, irritability and recurring vomiting episodes [9]. From the typical clinical manifestation, Wernicke's encephalopathy could be diagnosed [10].…”

Section: Discussionmentioning

confidence: 99%

Wernicke’s encephalopathy in a patient with severe acute pancreatitis after cholecystectomy and exploration of biliary tract

Lei

Liu

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Wernicke’s encephalopathy (WE) is a disease classically associated with thiamine deficiency,and generally presents with the triad of opthalmopathy, ataxia and altered mentality. However, and delayed diagnosis and treatment may lead to severe irreversible neurological damage, or even death. Only about 20% of the cases can be defined from the relevant literature, with the rest unnoticed and thus unreported. Here, we would like to report a case of a patient with severe acute pancreatitis who suffered from Wernicke’s encephalopathy after cholecystectomy and exploratory of biliary tract. Case presentation A 37-year-old Chinese male patient diagnosed with severe acute pancreatitis was admitted to our institute’s hospital for further treatment. The patient had a 50-days history of abdominal pain as well as 8-days emesis, and wasn’t addicted in alcohol consumption. He did not receive any regular physical examination or treatment. One months before cholecystectomy and exploratory of biliary tract,he was noted to have abdominal pain, poor appetite, emesis and sclera icterus .He was referred to the local hospital, received supportive treatment, including antibiotics and liver-protection drugs . However, he got worse after those treatment,so transferred from the local hospital to our hospital for further therapy.. After operationhe was admitted in general ward for further treatment. When his vital signs and laboratory examination came to stability. He recovered well with supportive treatments, including antibiotics, liver-protection, protecting gastric mucosa and so on. However,his oral intake was low, and he was solely dependent on total parenteral nutrition without vitamin B1. On the 7th post-operative day, psychiatric and neurological disorders appeared without an obvious cause, symptoms including babbling, irritability, apathy, non-purposeful movements, and dystaxia. On the basic of his clinical manifestations and brain magnetic resonance imaging scan results, Wernicke encephalopathy was eventully diagnosed. Conclusions Although extremely rare, this index patient highlights that Wernicke’s encephalopathy could be associated with severe acute pancreatitis. This is very helpful for the therapeutic implications and evaluating curative effect. A multivitamin and thiamine should be provided for patients who have a surgery of cholecystectomy and exploratory of biliary tract so as to prevent and cure Wernicke’s encephalopathy.

show abstract

“…Wernicke encephalopathy may result from prolonged total parenteral nutrition (thiamine deficiency). Changes in the patient's mental state are the most frequent manifestations (57). MR imaging findings include symmetrically increased signal intensity on FLAIR and T2-weighted MR images in the mammillary bodies, medial thalamus, periaqueductal area, and tectal plate; contrast enhancement can be seen in the same regions, most commonly in the mammillary bodies (3,16).…”

Section: Metabolic Disturbancesmentioning

confidence: 99%

Brain Imaging Findings and Neurologic Complications after Allogenic Hematopoietic Stem Cell Transplantation in Children

et al. 2018

View full text Add to dashboard Cite

Hematopoietic stem cell transplantation (HSCT) is the only therapy for a subset of patients with malignant and nonmalignant diseases. Central nervous system (CNS) complications continue to be an important cause of morbidity and significantly contribute to mortality after HSCT. These complications include infections, cerebrovascular lesions, therapy-induced diseases, metabolic disturbances, and post-HSCT carcinogenesis. Following HSCT, three phases can be identified on the basis of the patient's immune status: the pre-engraftment period (<30 days after HSCT), the early postengraftment period (30-100 days after HSCT), and the late postengraftment period (>100 days after HSCT). There is a distinct relationship between the patient's degree of immunodeficiency after HSCT and the incidence of various complications that may occur. Early diagnosis of CNS complications is crucial for successful management and a good prognosis, and computed tomography and magnetic resonance imaging play an important role in achieving these goals. The global increase in the use of HSCT requires radiologists to be familiar with CNS complications, their relationship to the patient's immune status, and their imaging appearances. This article describes the clinical background of HSCT; reviews the incidence, causes, and timeline of brain complications in children who underwent allogenic HSCT; and identifies the characteristic imaging findings of these disorders. RSNA, 2018.

show abstract

Diagnostic Clues to Human Herpesvirus 6 Encephalitis and Wernicke Encephalopathy After Pediatric Hematopoietic Cell Transplantation

Cited by 20 publications

References 48 publications

Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals

Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals

Wernicke’s encephalopathy in a patient with severe acute pancreatitis after cholecystectomy and exploration of biliary tract

Brain Imaging Findings and Neurologic Complications after Allogenic Hematopoietic Stem Cell Transplantation in Children

Contact Info

Product

Resources

About