Japanese viral encephalitis mimicking stroke with an initial manifestation of hemiplegia

Chen, Huanwen; Ding, Liang‐Wen; Lai, Chih-Cheng; Tseng, Tse-Kai; Liu, Wei-Lun

doi:10.1016/j.jmii.2011.09.009

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Additionally, in the present study of adult JE cases, stroke was among the most common neurological disorders after JE diagnosis over the study observation period. As reported in extreme cases, fever, headache, seizures, and changes in behavior or confusion could cause brain damage or even stroke [45,46]. This study, therefore, provides supportive evidence to highlight clinical importance of the early prevention, close follow-up for detection, and intervention of long-term neurological deficits in JE-infected adults following JE diagnosis.…”

Section: Neurological Complications Following Je Diagnosissupporting

confidence: 79%

Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015

Chen

Hsieh

et al. 2021

PLoS Negl Trop Dis

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Objective To assess the healthcare utilization, economic burden, and long-term neurological complications and mortality of an adult population with Japanese encephalitis (JE). Methods This study utilized two nationwide datasets in Taiwan: the Notifiable Disease Dataset of confirmed cases from the Centers for Disease Control to identify JE patients, and the National Health Insurance Research Database to obtain patients’ healthcare utilization. Survival analyses were performed to identify prognostic factors associated with the all-cause mortality of patients. Results This study included 352 adult cases with JE (aged≥20 years). The mean age of JE patients was 45 years. Stroke (event rate: 3.49/100 person-years) was the most common neurological complication, followed by epilepsy/convulsions (3.13/100 person-years), encephalopathy/delirium (2.20/100 person-years), and parkinsonism (1.97/100 person-years). Among the 336 hospitalized patients at JE diagnosis, 58.33% required intensive care. Among 79 patients who died following JE diagnosis, 48.84% of death events occurred within the year of diagnosis. The medical costs increased considerably at JE diagnosis and subsequent-year costs remained significantly higher than the costs before diagnosis (p<0.05). Having a four-dose JE vaccination (i.e., born after 1976) versus no JE vaccination history (i.e., born before 1963) was significantly associated with lower all-cause mortality (hazard ratio: 0.221 [95% confidence interval: 0.067, 0.725]). Comorbid diabetes and incident epilepsy/convulsion events significantly increased the mortality risk by 2.47- and 1.85-fold, respectively (p<0.05). Conclusion A considerable medical burden associated with JE was observed in affected adults, even in the years following JE diagnosis. Vaccination should be considered to prevent this sporadic, but lethal, viral infection.

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Section: Neurological Complications Following Je Diagnosissupporting

confidence: 79%

Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015

Chen

Hsieh

et al. 2021

PLoS Negl Trop Dis

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“…There are only sporadic case reports of meningitis as stroke mimic mainly associated with the presence of interesting (mostly bacterial) isolates in the culture results [16][17][18][19][20][21][22][23][24][25]. Data from meta-analyses also identify a low incidence of meningitis among stroke mimics [1,2,[26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Aseptic meningoencephalitis mimicking transient ischaemic attacks

et al. 2013

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Purpose To highlight meningoencephalitis as a transient ischaemic attack (TIA) mimic and suggest clinical clues for differential diagnosis. Methods This was an observational study of consecutively admitted patients over a 9.75-year period presenting as TIAs at a stroke unit. Results A total of 790 patients with TIAs and seven with TIA-like symptoms but a final diagnosis of viral meningoencephalitis were recognised. The most frequent presentations of meningoencephalitis patients were acute sensory hemisyndrome (6) and cognitive deficits (5). Signs of meningeal irritation were minor or absent on presentation. Predominantly lymphocytic pleocytosis, hyperproteinorachia and a normal cerebrospinal fluid (CSF)/serum glucose index (in 5 out of 6 documented patients) were present. Meningeal thickening on a brain magnetic resonance imaging (MRI) scan was the only abnormal imaging finding. Six patients received initial vascular treatment; one thrombolysed. Finally, six patients were treated with antivirals and/or antibiotics. Although neither bacterial nor viral agents were identified on extensive testing, viral meningoencephalitis was the best explanation for all clinical and laboratory findings. Conclusions Aseptic meningoencephalitis should be part of the differential diagnosis in patients presenting as TIA. The threshold for a lumbar puncture in such patients should be set individually and take into account the presence of mild meningeal symptoms, age and other risk factors for vascular disease, the results of brain imaging and the basic diagnostic work-up for a stroke source.

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Japanese viral encephalitis mimicking stroke with an initial manifestation of hemiplegia

Cited by 2 publications

References 7 publications

Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015

Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015

Aseptic meningoencephalitis mimicking transient ischaemic attacks

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