Viral infections of the CNS with special emphasis on herpes simplex infections

Schmutzhard, Erich

doi:10.1007/s004150170155

Cited by 119 publications

(86 citation statements)

References 62 publications

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“…36,37 However, the recently observed epidemic of the West Nile virus, newly recognized viruses such as the Nipah virus and the previously unnoticed association of viruses like the human herpes viruses 6 or 7 (HHV 6, HHV 7) or enterovirus 71 with CNS infections underline that agents other than HSV I have to be considered in acute encephalitis. Even in immunocompetent adults, HHV 6 can cause a chronic encephalitis (FIG.…”

Section: Viral Meningoencephalitismentioning

confidence: 99%

Neuroimaging of infections

2005

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Summary:Neuroimaging plays a crucial role in the diagnosis and therapeutic decision making in infectious diseases of the nervous system. The review summarizes imaging findings and recent advances in the diagnosis of pyogenic brain abscess, ventriculitis, viral disease including exotic and emergent viruses, and opportunistic disease. For each condition, the ensuing therapeutic steps are presented. In cases of uncomplicated meningitis, cranial computed tomography (CT) appears to be sufficient for clinical management to exclude acute brain edema, hydrocephalus, and pathology of the base of skull. Magnetic resonance imaging (MRI) is superior in depicting complications like sub-/epidural empyema and vasculitic complications notably on FLAIR (fluid-attenuated inversion recovery)-weighted images. The newer technique of diffusionweighted imaging (DWI) shows early parenchymal complications of meningitis earlier and with more clarity and is of help in differentiation of pyogenic abscess (PA) from ring enhancing lesions of other etiology. Proton magnetic resonance spectroscopy (PMRS) seems to produce specific peak patterns in cases of abscess. The presence of lactate cytosolic amino acids and absence of choline seems to indicate PA. Also in cases of suspected opportunistic infection due to toxoplasma DWI may be of help in the differentiation from lymphoma, showing no restriction of water diffusion. In patients with herpes simplex and more exotic viruses like West Nile and Murray Valley virus DWI allows earlier lesion detection and therapeutic intervention with virustatic drugs.

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Section: Viral Meningoencephalitismentioning

confidence: 99%

Neuroimaging of infections

2005

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“…The clinical presentation of viral encephalitis is non-specific and can include fever, neurological deficits and seizures. Although seizures can occur frequently during the acute phase (Misra et al, 2008), epidemiological analyses have demonstrated that CNS infections are a major cause of acquired epilepsy (Annegers et al, 1988;Hauser and Kurland, 1975;Marks et al, 1992;Rantakallio et al, 1986;Rocca et al, 1987), as well as neurological morbidity, including memory impairment and behavioural abnormalities (Chen et al, 2006;McGrath et al, 1997;Raschilas et al, 2002;Schmutzhard, 2001;Whitley et al, 1977), even after the infection has resolved.…”

Section: Introductionmentioning

confidence: 99%

Viral-like brain inflammation during development causes increased seizure susceptibility in adult rats

Galic

Riazi

Henderson

et al. 2009

Neurobiology of Disease

101

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Viral infections of the CNS and their accompanying inflammation can cause long-term neurological effects, including increased risk for seizures. To examine the effects of CNS inflammation, we infused polyinosinic: polycytidylic acid, intracerebroventricularly to mimic a viral CNS infection in 14 day-old rats. This caused fever and an increase in the pro-inflammatory cytokine, interleukin (IL)-1β in the brain. As young adults, these animals were more susceptible to lithium-pilocarpine and pentylenetetrazol-induced seizures and showed memory deficits in fear conditioning. Whereas there was no alteration in adult hippocampal cytokine levels, we found a marked increase in NMDA (NR2A and C) and AMPA (GluR1) glutamate receptor subunit mRNA expression. The increase in seizure susceptibility, glutamate receptor subunits, and hippocampal IL-1β levels were suppressed by neonatal systemic minocycline. Thus, a novel model of viral CNS inflammation reveals pathophysiological relationships between brain cytokines, glutamate receptors, behaviour and seizures, which can be attenuated by anti-inflammatory agents like minocycline.

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“…HSV2 infection of brain usually occurs in neonates. 17 Both HSV1 18 and HHV6 19 can cause central nervous system infection in immunocompetent persons. Herpes virus infection of the central nervous system can lead to acute encephalitis but can also cause self-limited infection.…”

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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Viral infections of the CNS with special emphasis on herpes simplex infections

Cited by 119 publications

References 62 publications

Neuroimaging of infections

Neuroimaging of infections

Viral-like brain inflammation during development causes increased seizure susceptibility in adult rats

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

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