Psychiatric Aspects of Herpes Simplex Encephalitis,
Tick-Borne Encephalitis and Herpes Zoster Encephalitis
Among Immunocompetent Patients

Więdłocha, Magdalena; Marcinowicz, Piotr; Stańczykiewicz, Bartłomiej

doi:10.17219/acem/40460

Cited by 12 publications

(12 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The inflammatory process of the limbic cortex may also manifest in disorganized behavior and emotional dysregulation occurring during the course of HSE. An altered mental state is often preceded by a period of delirium [4]. We did not observe the other mentioned psychotic symptoms except for disorganized behavior in our patient, which might be related to his level of consciousness during the initial evaluation.…”

contrasting

confidence: 70%

See 1 more Smart Citation

Kaposi’s varicelliform eruption in herpes simplex encephalitis

Yeh¹,

Lin

Chiu

et al. 2015

Intern Emerg Med

View full text Add to dashboard Cite

A 28-year-old man with a history of atopic dermatitis developed a widespread, erythematous rash on his middle abdomen, bilateral thigh, and chest for 1 week. He had complained of a severe headache, and gradually became drowsy, and therefore he had been sent to the emergency department (ED). In the ED, the patient presented with a fever of 39°C, a tonic-clonic seizure, disorganized behavior and a reduction in consciousness with a Glasgow Coma Scale score of 8. Physical examination revealed generalized, erosive, monomorphic vesicles as well as a coalescing skin rash, except for the palms, soles, and the genital region (Fig. 1a). The patient had a head computed tomography (CT scan) after his condition was stabilized, but there were no significant findings of the initial scan. Under the impression of a CNS infection, immediate lumbar puncture was performed in the ED to get an early diagnosis. Cerebrospinal fluid (CSF) analysis showed a predominance of lymphocytes, elevation of red blood cell (lymphocyte count 8/lL, RBC count 352/lL and total cell counts 360/lL), there was a normal opening pressure, and there was no traumatic tap during the procedure. The CSF glucose level was 80 mg/dL (serum glucose level was 101 mg/dL, CSF/blood ratio [0.6), and the CSF total protein was 27 mg/dL. A complete blood count analysis revealed a leukocytosis (WBC count 18.68 9 10 3 /lL); an elevation of C-reactive protein (6.37 mg/L) was also observed. A T2 fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging of the brain showed asymmetric hyperintensity over both temporal lobes (Fig. 1b). The imaging studies supported the diagnosis of herpes simplex encephalitis (HSE), and intravenous acyclovir was started immediately. Laboratory examinations confirmed the diagnosis subsequently after admission.Herpes simplex encephalitis (HSE) is the most common cause of sporadic viral encephalitis that is characterized by a severe headache, fever, seizures, and a decline in consciousness. In adults, the majority of cases are caused by HSV-1, which is believed to represent the reactivation of latent HSV in situ within the central nervous system. The diagnosis of herpes simplex encephalitis is based on clinical features (a triad of fever, headache and an altered mental state), cerebrospinal fluid examination, and brain imaging [1]. HSV DNA detection by polymerase chain reaction using the cerebrospinal fluid has a sensitivity of 98 % and a specificity of 94-100 %. Edematous changes in the temporal lobe and high red cell count in the CSF are typical features of HSE, and were observed in our patient [2]. The association between poor outcome and the

show abstract

contrasting

confidence: 70%

“…The temporal and orbitofrontal lobes involvement may also elicit personality changes, anosmia, or olfactory or gustatory hallucinations in the acute phase [4]. The inflammatory process of the limbic cortex may also manifest in disorganized behavior and emotional dysregulation occurring during the course of HSE.…”

mentioning

confidence: 99%

Kaposi’s varicelliform eruption in herpes simplex encephalitis

Yeh¹,

Lin

Chiu

et al. 2015

Intern Emerg Med

View full text Add to dashboard Cite

show abstract

“…Alterações cognitivas e comportamentais relacionadas à encefalite herpética são conhecidas e descritas na literatura como amnésias, afasias, mudanças de personalidade, alucinações e desinibição [5][6][7][8][9] . O paciente apresentou gravíssimas alterações de comportamento, que poderiam ser resultantes não apenas da lesão sequelar da infecção, mas também da gravidade dessas lesões, capazes de originar um foco epiléptico em seu lobo temporal.…”

Section: Discussionunclassified

“…Mesmo os sobreviventes que foram tratados apresentam importantes sequelas, em uma proporção elevada, conforme se nota em alguns estudos 5 . O diagnóstico de certeza deve envolver a reação de cadeia de polimerase para herpes vírus 6,7 , que é utilizada como padrão em trabalhos sobre a temática 7,8 . Pacientes com doenças orgânicas que cursam com manifestações psiquiátricas são um constante desafio.…”

Section: Introductionunclassified

“…Pacientes com doenças orgânicas que cursam com manifestações psiquiátricas são um constante desafio. A investigação diagnóstica extensa é extremamente importante e pode revelar novas patologias envolvidas, como mostram muitos trabalhos [5][6][7]9 . No caso em tela, o paciente apresentou complicações e alterações de comportamento secundárias à encefalite herpética, além de crises epilépticas.…”

Section: Introductionunclassified

See 1 more Smart Citation

Alterações de comportamento na encefalite herpética: um caso polimórfico e de difícil manejo

Oliveira¹,

Madeira²,

Celmer³

2015

J. bras. psiquiatr.

View full text Add to dashboard Cite

RESUMOA encefalite herpética é uma doença de alta mortalidade que deve ser diagnosticada e tratada rapidamente. Cefaleia, febre e alteração de comportamento compõem a tríade clássica. Há escassos estudos sobre o tema e nenhum a respeito do manejo das manifestações psiquiátricas. O relato de caso se refere a paciente de 35 anos, que manifestou a tríade clássica, sendo diagnosticado e tratado corretamente. Após um mês, apresentou desorganização do comportamento e agitação, sendo reinternado. Foi descartada recidiva e, por sua grave agitação, ele foi transferido à Psiquiatria. Permaneceu internado por 116 dias; nesse período, teve seguidos episódios de agitação e heteroagressividade, sendo restrito ao leito na maior parte do tempo. Apresentou crises epilépticas do tipo parcial complexa, somente realizando eletroencefalograma sob a terapêutica de três anticonvulsivantes, quando pôde colaborar para a realização do exame, com resultado normal. Houve intercorrências infecciosas tratadas, e conseguiu-se estabilização parcial com o uso de seis psicotrópicos em doses elevadas. Na alta, apresentava comportamento desorganizado, dé-ficit de memória, raciocínio fragmentado, construção de conceitos de forma errática, com interpretações delirantes, impulsividade latente, mas sem agressividade. Desafios do caso: internação prolongada pela refratariedade terapêutica, riscos, desgaste físico e emocional para paciente, família e equipe de saúde. O resultado final demonstra a possibilidade de melhora parcial em um caso polimórfico de encefalite herpética. ABSTRACTHerpes encephalitis is a high-mortality disease that must be quickly diagnosed and treated. Headache, fever and behavioral changes are the classic triad. There are few studies on the topic and none focus specifically on the management of psychiatric manifestations. The case report refers to 35-year-old patient who had those symptoms and was diagnosed and treated properly. One month later he showed disorganized behavior and agitation, and was readmitted. Herpes infection relapse was discarded, and he was transferred to the psychiatric ward, where he remained hospitalized for 116 days. During that time he became more agitated and even aggressive, and at one point began to undergo complex

show abstract