Early diagnosis of herpes simplex encephalitis by MRI

Schroth, Gerhard; Gawehn, Joachim; Thron, A; Vallbracht, Angelika; Voigt, Karsten

doi:10.1212/wnl.37.2.179

Cited by 275 publications

(109 citation statements)

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“…All AD patients met NINCDS-ADRDA criteria for probable AD(20). At entry into study, each AD participant was required to have relatively mild dementia operationalized as a modified Mini Mental State Examination (MMSE) Score(21) >= 30, equivalent to a score of >= 16 on the standard Folstein MMSE(22). Patients with DLB were diagnosed according to the 1996 consensus guidelines for the disease.…”

Section: Methodsmentioning

confidence: 99%

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

Ornstein

Gaugler

Devanand

et al. 2013

The American Journal of Geriatric Psychiatry

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Objectives The behavioral and psychological symptoms associated with dementia (BPSD) are highly burdensome to caregivers. While BPSD consist of a wide variety of patient behaviors including depression, physical aggression and paranoid delusions, it remains unclear whether specific symptoms have a differential impact on caregivers. The aims of this study were (1) to assess how individual BPSD symptoms, categorized based on how they may affect caregivers, impact depressive symptoms for dementia patient caregivers and (2) to test the pathways by which BPSD symptom clusters impact caregiver depressive symptoms. Design Cross-sectional analysis of data from a longitudinal study of patients with Alzheimer’s disease and Dementia with Lewy Bodies. Setting Multiple U.S. dementia clinics. Participants 160 patient-caregiver dyads. Methods Using multivariate GEE logistic models, we analyzed the relationship between four BPSD symptom clusters (patient depressive symptoms, accusatory/aggressive behaviors, non-threatening psychotic symptoms, and difficult to manage behaviors) and caregiver depressive symptoms and assessed mediators of these relationships. Results Only the presence of patient depressive symptoms was associated with caregiver depression (OR=1.55; 95% CI=1.14–2.1). This relationship was mediated by both caregiver report of the symptom’s impact on the patient and perceived burden to caregivers. Conclusions Patient depressive symptoms may be the most important driver of the relationship between BPSD and caregiver depression. Research in this field should further test the effects of individual BPSD symptoms and should also consider how symptoms may negatively impact caregivers by increasing burden and evoking empathy for the patient.

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Section: Methodsmentioning

confidence: 99%

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

Ornstein

Gaugler

Devanand

et al. 2013

The American Journal of Geriatric Psychiatry

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“…MRI with and without contrast is the neuroimaging study of choice in the evaluation of encephalitis and is abnormal in the vast majority of cases of HSVE [73]. MRI is the most sensitive and specific imaging method for HSVE, particularly early in the course of the illness [74].…”

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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“…33 Distinct brain regions such as the frontal and temporal lobes, and the insular cortex have been reported to show higher signal intensity in T2-weighted images in acute HSV1 encephalitis 34 possibly reflecting underlying tissue destruction owing to the infection. In a case report, progression of MRI abnormalities was observed even after the patient improved clinically and the polymerase chain reaction test of cerebrospinal fluid (CSF) was negative for HSV1 DNA.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2006

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Infectious agents have been proposed as one of the risk factors for schizophrenia. However, the data on the association of infectious agents with in vivo brain changes are scant. We evaluated the association of serological evidence of exposure to herpes simplex virus 1 (HSV1) with in vivo brain structural variations among first-episode antipsychotic-naive schizophrenia/ schizoaffective disorder patients and control subjects. We assayed HSV1 immunoglobulin G (IgG) antibody in serum samples from 30 patients and 44 healthy subjects and obtained structural magnetic resonance imaging scans from the same individuals. There were proportionately more patients with elevated HSV1 antibody ratios than healthy comparison subjects (v 2 = 3.98, 1 df, P = 0.046) and patients had significantly higher HSV1 IgG antibody ratios compared with healthy subjects. Using optimized voxel-based morphometry, we examined diagnosis by HSV1 serological status interaction followed by within-and betweengroup comparison across the serological status. We observed a diagnosis by HSV1 serological status interaction and a significant main effect of HSV1 serological status in the prefrontal gray matter. Patients exposed to HSV1 had decreased gray matter in Brodmann area 9 (dorsolateral prefrontal cortex) and 32 (anterior cingulate cortex) compared with patients without serological evidence of exposure to HSV1. HSV1-associated differences in brain structure were not detected among healthy subjects. These findings suggest that HSV1 exposure in schizophrenia is associated with specific regional gray matter differences that may not be attributable to medications, illness chronicity or comorbid substance use. This study provides suggestive evidence for a link between HSV1 exposure and some of the cerebral morphological changes often reported in schizophrenia.

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Early diagnosis of herpes simplex encephalitis by MRI

Cited by 275 publications

References 0 publications

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

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

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

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