Mild forms of herpes encephalitis.

Abstract

SUMMARY Three cases of herpes encephalitis are described. A definite diagnosis was established and all patients made a good recovery without specific antiviral chemotherapy. These reports are representative of those forms of herpes encephalitis with a good prognosis. It is suggested that the introduction of rapid non-invasive procedures will indicate a higher incidence of herpes encephalitis than is presently accepted. The relevance of repeated episodes of herpes encephalitis with respect to the aetiology of some psychiatric disorders and in the evaluation of antiviral agents is also discussed.The classic presentations of herpes encephalitis are those of severe diffuse meningoencephalitis or severe focal encephalitis.' 2 These conditions are exceptionally severe, cause a high mortality (ranging from 50 to 70%3) and a considerable degree of residual brain damage in survivors.45 It has been suggested67 that milder forms of herpes encephalitis should be recognised and in this paper we report three case histories which provide supportive evidence. In patients 1 and 3 the encephalitis was focal whilst in patient 2 it was more diffuse. All the patients made a good recovery without specific antiviral therapy. cytes, and protein of 1-78 g/l. Lumbar puncture was repeated on the following day, 255 lymphocytes were found and protein had risen to 2-02 g/l. The CSF lactate (2-9 mmol/1) was sufficiently elevated relative to blood lactate (0-9 mmol/l) to suggest a serous meningitis.9 An electroencephalogram (EEG) at this time suggested a right sided focus, a finding which was supported by an isotopic (99Tc) brain scan. The brain scan showed diffuse increased uptake of isotope centred on the right temporal lobe. No bacteria or viruses were isolated from CSF. Prednisolone therapy was commenced on the 10th hospital day, 50 mg/day was given for 7 days and then reduced; steroids were withdrawn completely over the next 6 weeks. On day 13 of hospitalisation she lapsed into unconsciousness and remained unconscious for 48 hours with no response to pain or loud noise, she did however respond to bright light. During this time her temperature returned to normal. On day 15, a right temporal lobe biopsy was taken. The brain was under moderate tension and found to be soft in consistency. The biopsy showed signs of early necrosis with some lymphocytic and plasma cell cuffing. No inclusions or acid fast bacilli were observed and the specimen was bacteriologically sterile. Herpesvirus simplex was isolated in cell culture (human embryo lung fibroblasts) within 24 hours. Retrospective CSF antibody assay indicated intrathecal synthesis of H simplex antibody (table 1).The day following brain biopsy her level of consciousness improved dramatically and thereafter continued to improve. Within 2 days she was oriented in time and place and her speech was coherent. Power, tone and reflexes returned gradually to normal. Eight days after biopsy she was sitting up and listening to the radio. A rapid almost complete recovery followed. Two months later her me...

Brain morphological changes associated with exposure to HSV1 in first-episode schizophrenia

“…Herpes virus infection of the central nervous system can lead to acute encephalitis but can also cause self-limited infection. 20 In human beings, latent HSV1 infection is maintained primarily in the trigeminal ganglia, although evidence for latent infection in cornea, brain and other non-brain tissues is mounting. 21 Reactivation of latent infection may be brought about by physical or emotional stress, 22 menstruation 23 and hormonal imbalance.…”

Herpes simplex virus tipo 1 como factor de riesgo asociado con la enfermedad de Alzheimer

“…Las primeras evidencias de que HSV-1 podía ser transportado hasta el sistema nervioso central (SNC) desde el sistema nervioso periférico, fueron obtenidas a partir de estudios acerca de la encefalitis causada por herpes simplex (HSE) 5,[9][10][11][12] .…”

Herpes Simplex Type 1 Encephalitis

“…However, completely atypical or chronic illness courses have also been reported (Bewermeyer et al, 1987;Panagariya et al, 2001;Whitley et al, 1989). Besides very mild courses, recurrent brain stem encephalitides were also defined (Klapper at al., 1984;Tyler et al, 1995). Because of this diversity of clinical symptoms, the diagnosis of the disease remains difficult and this causes the virostatic therapy to be applied very late.…”