MR imaging of adult acute infectious encephalitis

Bertrand, Anne; Leclercq, Delphine; Martinez-Almoyna, L.; Girard, Nadine; Stahl, J.-P.; Debroucker, Thomas

doi:10.1016/j.medmal.2017.01.002

Cited by 54 publications

(48 citation statements)

References 147 publications

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“…One of the peculiar points of our case in comparison with most cases of VZV encephalitis was that in our case, there were no features of vasculitis. e typical features of VZV encephalitis often present as an ischemic infarction with arterial stenosis [14]. In our patient, MRI did not support the presence of vasculitis and therefore an angiogram was not performed for our patient.…”

Section: Discussionmentioning

confidence: 68%

“…Cerebellar peduncle involvement in this case was likely the cause of the patient's significant gait ataxia. While imaging came back conclusive for a cerebellar lesion in our patient, if negative in another case, imaging cannot be dismissed since the sensitivity of MRI in detecting VZV lesions is largely unknown, due to the limited data [14]. e route of infection to the CNS is unclear, but research postulates spreading through hematogenous or CSF pathways [5].…”

Section: Discussionmentioning

confidence: 75%

“…In our patient, MRI did not support the presence of vasculitis and therefore an angiogram was not performed for our patient. Notably, in patients that do undergo an angiogram, a negative result does not rule out VZV vasculitis since angiogram is not sensitive to small-vessel vasculitis [14]. e standard treatment of RHS itself focuses on acyclovir and prednisone therapy.…”

Section: Discussionmentioning

confidence: 99%

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Brainstem and Cerebellar Involvement in Ramsay Hunt Syndrome

Letchuman

Donohoe

2019

Case Reports in Otolaryngology

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We present a case of a 62-year-old Caucasian male with laryngeal cancer and Ramsay Hunt Syndrome otherwise known as herpes zoster oticus due to reactivation of the varicella zoster virus. Classic findings include the triad of ipsilateral facial paralysis, otic pain, and herpetic lesions in the sensory supply of the facial nerve. e common pathogenesis is associated with anterograde axonal reactivation of the varicella zoster virus in the geniculate ganglion. Unique features of our case include retrograde transaxonal spread of the varicella-zoster virus from the geniculate ganglion into the brainstem and cerebellum including involvement of the abducens nucleus, facial nucleus, middle cerebral peduncle, and inferior cerebellar peduncle. is presented as left facial paralysis, left sixth nerve palsy, horizontal diplopia to the left lateral gaze, profound truncal ataxia, and left-sided dysmetria. Clinical awareness that Ramsay Hunt syndrome may also involve the brainstem and cerebellum is critical in evaluating the clinical neurologic findings and expanding the diagnostic workup to include brain magnetic resonance imaging and cerebrospinal fluid analysis, including varicella zoster polymerase chain reaction. Encephalitis requires longer duration administration of high-dose intravenous acyclovir in conjunction with steroids. Delays in treatment are often associated with unsatisfactory outcomes with extensive residual deficits.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Brainstem and Cerebellar Involvement in Ramsay Hunt Syndrome

Letchuman

Donohoe

2019

Case Reports in Otolaryngology

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“…Magnetic resonance imaging should be the first-line tool for investigation of encephalitis, as it is far more sensitive and specific than computed tomography. A recent review [14] summarized current knowledge about modern imaging in HSVE. Brain MRI has a high sensitivity for the diagnosis of HSVE, showing brain abnormalities in 80 to 100% of cases.…”

Section: Imagingmentioning

confidence: 99%

Herpes Simplex Virus Encephalitis: An Update

Stahl¹,

Mailles²

2019

mjima

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Herpes simpleks virüsü (HSV) erişkinlerde sporadik enfektif ensefalitin en sık nedenidir. Antiviral tedavilere rağmen, olgu fatalite oranı orta ila yüksek arasında değişen oranlarda (çalışma ve ülkelere göre %5 ila %30) değişmektedir. Tanı yöntemlerinin bir tarafında beyin omurilik sıvısında spesifik polimeraz zincir reaksiyonu testleri diğer tarafında manyetik rezonans görüntüleme yer almaktadır. Çeşitli ülkelerin tedavi rehberleri, günde üç kez sistemik 10 mg/kg asiklovir tedavisinin mikrobiyolojik doğrulama beklenmeden başlanmasını önermektedir. Diğer bir soru kortikosteroidlerin yararlı olup olmadığıdır. Bu soru geç dönem sekel sıklığı (hastaların %30-40'ı) ve yakın zamanda bildirilen HSV ile tetiklenen otoimmün ensefalit ile ilgilidir. Bu iki olası komplikasyonda, profilaktik tedavi olarak steroidler yararlı olabilir, ancak kesinlik kazanması için yapılacak spesifik klinik çalışmalara ihtiyaç vardır. Genetik özellikler yakın zamanda tanımlanmış ve bazı hastalardaki ensefalit oluşumunu açıklamıştır, ancak henüz tüm olguları açıklayamamaktadır. Anahtar Kelimeler: Asiklovir, herpes simpleks virüs, sekel, otoimmün ensefalit, gansiklovir ÖzHerpes simplex virus (HSV) is the most frequent cause of sporadic infective encephalitis in adults. Despite antiviral therapies, the case fatality rate is moderate to high (5 to 30% according studies and countries). Tools for diagnosis are specific polymerase chain reaction testing of the cerebrospinal fluid on one hand and magnetic resonance imaging on the other hand. Guidelines of various countries recommend systematic treatment by acyclovir 10 mg/kg, three times a day, starting before microbiological confirmation. The remaining question is the usefulness of corticosteroids. This question is related to the frequency of late sequalae (30 to 40% of patients) and the recent demonstration of auto-immune encephalitis triggered by HSV encephalitis. These two possible complications suggest the usefulness of steroids as prophylactic treatment but specific clinical trials are needed for confirmation. Genetic features were recently identified, explaining encephalitis occurrence in some patients, but do not explain all cases so far.

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“…Magnetic resonance imaging is the gold standard technique for brain imaging in encephalitis, 12 and is abnormal in 90% of cases of HSV encephalitis, 4 but may be normal or subtly abnormal in autoimmune encephalitis (Fig 2 ). 13 Further imaging techniques including ultrasonography, CT of the body and positron emission tomography (PET) imaging may be indicated if a paraneoplastic cause is suspected 14 (for example in N-methyl D-aspartate receptor [NMDAR] antibody encephalitis, which may be associated with ovarian teratoma in young females).…”

mentioning

confidence: 99%