Encephalitis lethargica and the influenza virus. III. The influenza pandemic of 1918/19 and encephalitis lethargica: neuropathology and discussion

Foley, Paul

doi:10.1007/s00702-009-0296-8

Cited by 15 publications

(8 citation statements)

References 56 publications

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“…This is so because, patients who died in the middle of influenza endemic period might well be classified, without any further investigation, as a death caused by flu. [4] This is also the case especially for the management of elderly patients which, if inappropriate, may cause serious delays for the proper treatment of disease.…”

Section: Discussionmentioning

confidence: 99%

Acute hypercapnic respiratory failure as a rare complication of meningoencephalitis: Two case reports

Grigorakos

Tzortzopoulou

Alexopoulou

et al. 2017

CRIM

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Background: Differentiated diagnosis of meningoencephalitis in elderly patients, when an uncommon picture of respiratory infection leading to acute hypercapnic respiratory failure (AHRF) and without neurological signs is present, may raise serious difficulties. Case report: Two patients aged 72 (patient 1) and 75 (patient 2), without any medical history of respiratory problems, were hospitalized during spring with influenza symptoms. Within less than 24 hours from their admission, patients developed AHFR, which led to disturbances of arterial blood gases (ABGs). They were intubated and transferred, mechanically ventilated, to our intensive care unit (ICU). After normalization of ABGs, a weaning process followed. Weaning was unsuccessful, as unexpected neurological semiotics occurred. The imaging of neurological MRI revealed no special damage apart from microangiopathy. Further investigations through lumbar puncture with cerebrospinal fluid (CSF) testing revealed meningoencephalitis. Antiviral treatment was applied and the outcome was successful for both patients. Conclusion: Critical care medical personnel should be aware of the event of viral meningoencephalitis in elderly patients with AHRF. Especially in the middle of influenza endemic periods, the management of elderly patients may not be appropriate, thus resulting in serious delays for a proper treatment of disease. Laboratory screening of blood and urine, as well as other body fluids, can help detect and determine brain infection. Results from these tests can help exclude other diseases that mimic meningoencephalitis. In cases of patients who are hospitalized in the ICU due to AHRF and do not exhibit neurological abnormalities from the onset of illness, lumbar puncture and check of CSF should be a routine examination. Prophylactic vaccination of high-risk groups may be of crucial importance for preventing complications in patients who develop meningoencephalitis. However, once infected with this disease, the positive outcome is highly dependent on the immediate diagnosis and proper treatment of patients in the ICU.

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Section: Discussionmentioning

confidence: 99%

Acute hypercapnic respiratory failure as a rare complication of meningoencephalitis: Two case reports

Grigorakos

Tzortzopoulou

Alexopoulou

et al. 2017

CRIM

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“…EL preceded the 1918 influenza pandemic, had a distinct clinical picture and unique pathology. EL was associated with midbrain lesions, while influenza was associated with pulmonary lesions [8, 10, 18, 52]. …”

Section: Discussionmentioning

confidence: 99%

“…The relationship between EL and influenza has been examined historically and scientifically, with most EL researchers maintaining that influenza is an unlikely cause of EL [10, 11, 52]. Others suggest that the association cannot be ruled out [7, 12, 58].…”

Section: Discussionmentioning

confidence: 99%

The Demise of Poskanzer and Schwab’s Influenza Theory on the Pathogenesis of Parkinson’s Disease

Estupinan

Nathoo

Okun

2013

Parkinson's Disease

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In 1961, David C. Poskanzer and Robert S. Schwab presented a paper, “Studies in the epidemiology of Parkinson's disease predicting its disappearance as a major clinical entity by 1980.” This paper introduced the hypothesis that Parkinson's disease was derived from a single aetiology, the influenza virus. We review the original Poskanzer and Schwab hypothesis that Parkinson's disease was based on the association between the 1918-19 influenza epidemic and the later observation of Parkinsonism in some influenza sufferers. We also further explore the prediction that Parkinson's disease would totally disappear as an entity once original influenza victims were all deceased. Current research has revealed that there are many potential causes and factors important in the occurrence of Parkinson's disease, postencephalitic Parkinsonism, and encephalitis lethargica. Poskanzer and Schwab presented a novel hypothesis; however, it was proven false by a combination of research and time.

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“…'' There has been a recent resurgence of interest in EL. [88][89][90][91][92][93][94] The EL epidemic raises questions for microbiology, immunology, neuropathology, and other disciplines but its literature can also be read as a contribution to the history of clinical phenomenology. EL represents an example of how traditional understandings of symptoms and signs can be challenged by unfamiliar clinical syndromes, contributing to the development of new neurological and psychiatric concepts.…”

Section: Discussionmentioning

confidence: 99%

On doing nothing: Descriptions of sleep, fatigue, and motivation in encephalitis lethargica

Ward

2011

Movement Disorders

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Epidemics of encephalitis lethargica (EL), from 1917 to the 1930s, are an important milestone in the history of movement disorders. Today, the two best-known features of EL are somnolence and parkinsonism but the full clinical picture was variable and complex. States of wakeful inactivity--as opposed to drowsiness--were often described both in the acute and postacute stages and were referred to in the EL literature as "lethargy" or "torpor." The study described here is based on a survey of clinical descriptions published in English, French, and German from 1917 to 1942. Its focus is on the history of clinical ideas, rather than applying modern pathophysiological concepts retrospectively. Descriptions of lethargy are explored as a way of elucidating concepts of sleep, fatigue, and motivation during the study period. The literature described many patients who had (1) lethargy without interruption in consciousness; (2) slowness of movement and catalepsy without other prominent parkinsonian features; and (3) apathy and lack of initiative without severe disorders of mood or thought content. Hence observers distinguished a state of wakeful inactivity from primary disorders of sleep, movement and behavior. Contemporaneous accounts suggest that writers had difficulty in reconciling their observations with preexisting concepts; there still may be limitations in our ability to describe and classify the clinical states connected during the epidemic era with the term "lethargy."

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Encephalitis lethargica and the influenza virus. III. The influenza pandemic of 1918/19 and encephalitis lethargica: neuropathology and discussion

Cited by 15 publications

References 56 publications

Acute hypercapnic respiratory failure as a rare complication of meningoencephalitis: Two case reports

Acute hypercapnic respiratory failure as a rare complication of meningoencephalitis: Two case reports

The Demise of Poskanzer and Schwab’s Influenza Theory on the Pathogenesis of Parkinson’s Disease

On doing nothing: Descriptions of sleep, fatigue, and motivation in encephalitis lethargica

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