Computed tomographic findings in acute viral encephalitis in adults with emphasis on herpes simplex encephalitis

Weisberg, Leon A.; Greenberg, Jack; Stazio, Antonio

doi:10.1016/0895-6111(88)90082-1

Cited by 9 publications

(4 citation statements)

References 11 publications

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“…Abnormal findings have been observed in 25-80 % of patients with HSVE imaged soon after admission [62,69]. CT findings suggestive of HSVE include hypodense lesions (typically in the temporal lobe), edema, or contrast enhancement [70][71][72]. However, CT is unable to differentiate between HSVE and many of its mimics, and lacks sensitivity, particularly early in the course of the illness.…”

Section: Neuroimagingmentioning

confidence: 99%

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

2016

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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.

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Section: Neuroimagingmentioning

confidence: 99%

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

2016

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“…Computed tomography (CT) reveals abnormal areas in the brain of 25% to 80% of patients with HSE if they are imaged shortly after admission (11, 12). The findings normally include hypodense regions, edema, or areas of increased contrast (13–15). Perivascular lymphocytic cuffing in pons, midbrain, and temporal lobe, along with multiple petechial hemorrhages and ecchymosis, has been noted in association with HSE (16).…”

Section: Introductionmentioning

confidence: 99%

Herpes Simplex Virus 1 Induces Brain Inflammation and Multifocal Demyelination in the Cotton Rat Sigmodon hispidus

Boukhvalova

Mortensen

Mbaye

et al. 2019

J Virol

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Our work demonstrates for the first time a direct association between infection with herpes simplex virus 1, a ubiquitous human pathogen generally associated with facial cold sores, and multifocal brain demyelination in an otherwise normal host, the cotton rat Sigmodon hispidus. For a long time, demyelinating diseases were considered to be autoimmune in nature and were studied by indirect methods, such as immunizing animals with myelin components or feeding them toxic substances that induce demyelination. Treatment against demyelinating diseases has been elusive, partially because of their unknown etiology. This work provides the first experimental evidence for the role of HSV-1 as the etiologic agent of multifocal brain demyelination in a normal host and suggests that vaccination against HSV-1 can help to combat demyelinating disorders.

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“…Although the CSF protein count was normal, this can often be the case with viral encephalitis [2]. Additionally this was supported by the initial image findings of right hemispheric oedema with focal enhancement in the temporal lobe, which again is typical of viral encephalitis [3].…”

Section: Case Presentationmentioning

confidence: 48%

Gliomatosis Cerebri Mimicking Viral Encephalitis – A Case Report

Whitlow¹,

Saleh²,

Rahman³

2017

J Neurol Neurosci

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We present a case of a patient with a radiological diagnosis of gliomatosis cerebri whose clinical presentation mimicked that of viral encephalitis. A 69-year-old female presented with a few days history of confusion, headache and fever. Examination revealed mild extensor weakness in the left upper and lower limb. CSF showed a mild pleocytosis; gram stain, bacterial and viral cultures as well as HSV PCR were negative. CT brain showed diffuse right hemispheric oedema with a focal enhancement in the temporal lobe, which was also demonstrated on MRI brain. Aciclovir and dexamethasone were started for presumed viral encephalitis. After 8 days of treatment, the patient's symptoms improved and she was discharged. One week later, the patient was more confused with new left sided hemianopia. Repeat MRI brain revealed progression of the diffuse right-sided oedema, extending into the corpus callosum and cerebellum. Following discussion with a specialist neurooncology centre, we were advised that the images were indicative of extensive Gliomatosis Cerebri. Unfortunately, the patient died of pneumonia before tissue diagnosis was obtained. GC is a rare form of infiltrative glioma involving three or more lobes of the CNS. It has a varying clinical presentation and there are frequent case reports of GC mimicking alternative diagnoses. GC has been reported to mimic viral encephalitis in only one previous adult case.

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Computed tomographic findings in acute viral encephalitis in adults with emphasis on herpes simplex encephalitis

Cited by 9 publications

References 11 publications

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

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

Herpes Simplex Virus 1 Induces Brain Inflammation and Multifocal Demyelination in the Cotton Rat Sigmodon hispidus

Gliomatosis Cerebri Mimicking Viral Encephalitis – A Case Report

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