Diffusion-weighted MRI abnormalities as a clue to the diagnosis of herpes simplex encephalitis

McCabe, Kenneth J.; Tyler, Ken; Tanabe, Jody

doi:10.1212/01.wnl.0000082387.97051.f5

Cited by 93 publications

(33 citation statements)

References 6 publications

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“…McCabe et al [77] reported an adult with HSVE in whom HSV PCR was negative, but early diffusion restriction was observed in the anterior temporal lobes and the insular cortex. More reports demonstrating improved sensitivity of DWI over fluid-attenuated inversion recovery (FLAIR) sequences were soon to follow in adults [78], children [79], and neonates [80,81].…”

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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“…37 Hyperintense DWI abnormalities in the hippocampus have been reported in the initial stages of the disease and are accompanied by a reduction in the ADC that is likely the result of cytotoxic edema. 38 Serial MRIs in patients with HSE have revealed a reduction in the ADC in neocortical tissue within the first 5 to 6 days after the onset of the disease. Increased ADC values have also been reported, which likely reflects combined vasogenic and extracellular edema.…”

Section: Hippocampal Inflammationmentioning

confidence: 99%

Selective Neuronal Vulnerability of Human Hippocampal CA1 Neurons: Lesion Evolution, Temporal Course, and Pattern of Hippocampal Damage in Diffusion-Weighted MR Imaging

Bartsch

Döhring

Reuter

et al. 2015

J Cereb Blood Flow Metab

128

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The CA1 (cornu ammonis) region of hippocampus is selectively vulnerable to a variety of metabolic and cytotoxic insults, which is mirrored in a delayed neuronal death of CA1 neurons. The basis and mechanisms of this regional susceptibility of CA1 neurons are poorly understood, and the correlates in human diseases affecting the hippocampus are not clear. Adopting a translational approach, the lesion evolution, temporal course, pattern of diffusion changes, and damage in hippocampal CA1 in acute neurologic disorders were studied using high-resolution magnetic resonance imaging. In patients with hippocampal ischemia (n = 50), limbic encephalitis (n = 30), after status epilepticus (n = 17), and transient global amnesia (n = 53), the CA1 region was selectively affected compared with other CA regions of the hippocampus. CA1 neurons exhibited a maximum decrease of apparent diffusion coefficient (ADC) 48 to 72 hours after the insult, irrespective of the nature of the insult. Hypoxic-ischemic insults led to a significant lower ADC suggesting that the ischemic insult results in a stronger impairment of cellular metabolism. The evolution of diffusion changes show that CA1 diffusion lesions mirror the delayed time course of the pathophysiologic cascade typically observed in animal models. Studying the imaging correlates of hippocampal damage in humans provides valuable insight into the pathophysiology and neurobiology of the hippocampus.

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“…In this clinical case report, the initial absence of neurological signs was misleading. Mental deterioration was attributed to hepatic portal-systemic encephalopathy and no brain CT or MRI [4] were initially performed. The persistent fever could be explained by the different concomitant illness such as pneumonia, urinary and skin infections.…”

Section: Discussionmentioning

confidence: 99%

A misleading case of encephalitis in cirrhotic diabetic patient: The importance of early diagnosis

Rigato

Vitturi

Avogaro

2014

CRIM

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We present the case of a 67 year-old cirrothic man, referred to our hospital for disorientation, hyporexia, nausea, vomiting and hyperglycemia. At admission he was pyretic and disoriented, no neurological signs were present and laboratory examination showed mild hyperammonemia with normal inflammatory markers. Chest X-ray demonstrated a probable pneumonia and urinary infection was found, therefore systemic antibiotic therapy was initiated. After one week of antibiotic therapy, despite hyperammonemia resolution, the patient remained pyretic with progressive worsening of his mental state. Head CT scan was performed, demonstrating a large hypodense area in temporal lobe confirmed by brain MRI. Lumbar puncture was immediately performed and CSF PCR revealed HSV1-DNA positivity. Antiviral therapy with acyclovir at dosage of 10 mg/kg daily was initiated and continued for three weeks with complete defervescence, partial improvement of the state of consciousness and negativity of HSV1-DNA on CSF control. Two months later the patient was hospitalized again for urinary sepsis and developed a fatal frontal-parietal-temporal cerebral empyema. In cirrothic encephalopatic patient with persistent hyperpyrexia and normal or slight incremented inflammatory markers, herpetic encephalitis must be suspected even without neurological signs. Diagnosis retardation could be associated with elevated morbidity and mortality.

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Diffusion-weighted MRI abnormalities as a clue to the diagnosis of herpes simplex encephalitis

Cited by 93 publications

References 6 publications

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

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

Selective Neuronal Vulnerability of Human Hippocampal CA1 Neurons: Lesion Evolution, Temporal Course, and Pattern of Hippocampal Damage in Diffusion-Weighted MR Imaging

A misleading case of encephalitis in cirrhotic diabetic patient: The importance of early diagnosis

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