Elsberg syndrome in HSV-2 infection

Belfaqeeh, Omar; Markley, Alexandria; Patel, Mudita; Markoff, Brian; Osorio, Georgina

doi:10.1016/j.idcr.2023.e01714

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…Classically, a ring-enhancing leptomeningeal lesion is most suggestive of LC but can also be found in leptomeningeal lymphoma, meningitis, autoimmune and inflammatory diseases such as sarcoidosis, and trauma. 4 Lumbar puncture with CSF analysis is often the next step in management, as it can help to differentiate these causes. CSF findings for each of these conditions are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Elsberg Syndrome: A Case Report of a Novel Radiographic Presentation

Lyons,

Dixit

2024

The Neurohospitalist

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Introduction: Elsberg syndrome (ES) presents with bowel and bladder dysfunction, resembling cauda equina syndrome, and is classified as a clinicoradiographic syndrome most commonly associated with HSV-2 reactivation. Most cases reveal smooth and continuous nerve enhancement on imaging. Case Description: We present a unique case of ES that presented as several nodular, ring enhancing soft tissue masses along the cauda equina. An 81-year-old woman presented with several weeks of sacral sensory impairment. MRI of the lumbar spine at presentation showed several nodular, ring enhancing soft tissue masses within the thecal sac along the cauda equina, concerning for leptomeningeal carcinomatosis from an unknown primary source. Cerebrospinal fluid (CSF) analysis was notable for lymphocyte predominant pleocytosis and protein elevation, which was nonspecific but suggestive of leptomeningeal carcinomatosis. CSF rapid meningitis panel was positive for HSV2 which was confirmed on HSV2 PCR. The patient was briefly on on acyclovir and was stopped due to lack of meningioencephalitis symptoms. Malignancy workup with cytological analysis and systemic imaging were negative. Given the absence of malignancy and positive HSV2 PCR, the patient was diagnosed with HSV-2 sacral radiculitis and subsequently treated with a full course of intravenous acyclovir with gradual clinical and radiographic improvement. Discussion: Ring-enhancing lesions along the cauda equina are most suggestive of LC. Our case highlights an as of yet unreported presentation of ES which may be valuable for neurologists to be aware of as to avoid any potential diagnostic dilemma, minimize unnecessary and costly testing, and not delay effective treatment.

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Section: Discussionmentioning

confidence: 99%

Elsberg Syndrome: A Case Report of a Novel Radiographic Presentation

Lyons,

Dixit

2024

The Neurohospitalist

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Atypical Presentation of Elsberg Syndrome Caused by Herpes Simplex Virus Type 2 Infection

Je,

No,

Park

2024

J Korean Neurol Assoc

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Elsberg syndrome is a rare disease of lumbosacral myeloradiculitis, mostly caused by herpes simplex virus type 2 (HSV-2). It frequently has concomitant myelitis, and immunocompromised patients can be fatal with ascending myelitis. Since anti-viral agents might lead to good recovery, clinicians need to be suspicious for conditions of cauda equina syndrome. Detection of viral DNA from cerebrospinal fluid ensures the diagnosis. We report a case of Elsberg syndrome caused by HSV-2 and are to delineate the clinical and radiologic spectrum.

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Elsberg syndrome in HSV-2 infection

Cited by 2 publications

References 9 publications

Elsberg Syndrome: A Case Report of a Novel Radiographic Presentation

Elsberg Syndrome: A Case Report of a Novel Radiographic Presentation

Atypical Presentation of Elsberg Syndrome Caused by Herpes Simplex Virus Type 2 Infection

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