Use of Clinical and Neuroimaging Characteristics to Distinguish Temporal Lobe Herpes Simplex Encephalitis From Its Mimics

Chow, Felicia C; Glaser, Carol; Sheriff, Heather; Xia, Dongxiang; Messenger, Sharon; Whitley, Richard; Venkatesan, Arun

doi:10.1093/cid/civ051

Cited by 77 publications

(103 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As well, involvement of the basal ganglia, thalamus, and (orbital) frontal lobe may appear; our series changes were even bilateral in 53 % of patients (Chow et al 2015;Domingues et al 1998;Oyanguren et al 2013;Sili et al 2014). Our study suggests the superiority of DWI to conventional T2-or FLAIR-weighted MRI in detection of early signal abnormalities in HSVE (Renard et al 2015).…”

Section: Mri Imagingsupporting

confidence: 53%

A study on viral CNS inflammation beyond herpes encephalitis

et al. 2016

View full text Add to dashboard Cite

The early diagnosis of herpes simplex virus encephalitis (HSVE) enables induction of antiviral therapy in this potentially life-threatening disease. The study aimed to determine clinical findings including cerebrospinal fluid (CSF) data and MRI imaging in HSVE patients and to identify features distinguishing HSVE from encephalitis of other viral etiologies. We retrospectively reviewed consecutive patients who were diagnosed with viral encephalitis between 2000 and 2014 at the University Hospital Halle. Forty-nine patients with viral encephalitis were identified. A viral etiology could be confirmed by PCR or antibody testing in 22/49 (44.9 %) of patients (15 (30.6 %) HSV, 5 (10.2 %) VZV, 2 (4.1 %) EBV). In HSVE, typical findings were focal slowing in electroencephalophy (EEG) (80 %, p = 0.021) and presence of cortical (86.7 %, p = 0.030) lesions in MRI. Restricted diffusion was particularly helpful in detection of early signal abnormalities in HSVE (p = 0.014). In 27/49 (55.1 %) of patients, no causative agent could be elucidated. In these patients, 15/27 (55.6 %) experienced a rather "benign" disease course with no MRI pathology despite initially HSVE mimicking clinical picture. However, CSF was significantly different showing a higher amount of granulocytes and activated lymphocytes. The remaining 12/27 (44.4 %) patients developed MRI changes consistent with encephalitis, in 4 of these patients, disease course was fatal. Beside PCR-based serology as standard procedure, MRI including diffusion-weighted images and EEG represent additional tools in early HSVE diagnosis. CSF cytology might be particularly supportive in differentiating likely benign forms of encephalitis.

show abstract

Section: Mri Imagingsupporting

confidence: 53%

A study on viral CNS inflammation beyond herpes encephalitis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…On the contrary, a recent study of cases of encephalitis with temporal lobe abnormalities found that bilateral temporal lobe involvement was associated with lower odds of HSVE compared with all other etiologies and when directly compared with autoimmune etiologies [84]. In that study of immune competent adults, patients with HSVE, as compared with other infectious or autoimmune etiologies of their temporal lobe encephalitis, were more likely to be older and white, and to present acutely and with fever, seizures, and upper respiratory symptoms.…”

Section: Neuroimagingmentioning

confidence: 83%

“…Chow et al [84] recently reviewed the clinical and neuroimaging features of 251 cases of temporal lobe encephalitis from the California Encephalitis Project. Among all cases of temporal lobe encephalitis, 43 % were infectious and 16 % were noninfectious etiologies.…”

Section: Differential Diagnosismentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

View full text Add to dashboard Cite

Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be lifesaving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.

show abstract

“…However, the constellation of an acute onset, a rapidly worsening short course of a vivid symptomatology can differentiate the prodrome of encephalitis from migraine. In addition to other procedures, the performance of an urgent magnetic resonance imaging (MRI) of the brain is indicated to confirm the clinical diagnosis of encephalitis [36].…”

Section: Encephalitismentioning

confidence: 99%

Preictal Symptomatology in Migraines: Diagnostic and Therapeutic Significance

Gupta¹,

Gupta²

2015

Journal of Headache &Amp; Pain Management

View full text Add to dashboard Cite

Prodrome and aura constitute preictal symptomatology of migraines. The objective of this clinical review is to examine the diagnostic and therapeutic significance of preictal symptomatology in children with migraines. The systemic review of the literature identified a single study in children with migraines. The majority studies were in adults. Based on our search and longitudinal clinical observation, we describe the clinical characteristics of diagnostic and therapeutic significance of preictal symptoms and various types of auras in migraines. Such significance can be substantially increased by including prodromal physical signs in children with migraines. Future studies' methodology should include physical signs in addition to symptoms and identify the spectrum of the various auras, and relate to their temporal association with ictal and postictal phases of migraines. In addition these clinical parameters should be statistically analyzed.

show abstract

Use of Clinical and Neuroimaging Characteristics to Distinguish Temporal Lobe Herpes Simplex Encephalitis From Its Mimics

Abstract: In addition to HSE, other infectious and noninfectious etiologies should be considered in the differential diagnosis for TL encephalitis, depending on the presentation. Specific clinical and imaging features may aid in distinguishing HSE from non-HSE causes of TL encephalitis.

Cited by 77 publications

References 30 publications

A study on viral CNS inflammation beyond herpes encephalitis

A study on viral CNS inflammation beyond herpes encephalitis

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Preictal Symptomatology in Migraines: Diagnostic and Therapeutic Significance

Contact Info

Product

Resources

About