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Delirium
Published in Henry J. Woodford, Essential Geriatrics, 2022
The limbic system consists of the hippocampus, thalamus, hypothalamus and amygdala (see page 117) located in the medial temporal lobes. Encephalitis is a broad term for brain inflammation. Inflammation of the limbic system can be caused by viral, paraneoplastic or autoimmune processes. A UK study identified 203 cases of encephalitis from 24 hospitals over a two-year period (i.e. around four per hospital per year).43 Cases had a median age of 30. The breakdown of aetiologies was as below:42% infectious (most commonly herpes simplex virus, occasionally Varicella zoster virus or Mycobacterium tuberculosis)37% had unknown causes21% had acute immune-mediated encephalitis
Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
Treatment – There is no specific treatment for WNV encephalitis, and supportive care is standard. Ribavirin does possess in vitro activity against WNV, and other therapies such as IFN and IVIG have been attempted; however, none has proven beneficial, and they cannot be recommended.
Encephalitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
The main presenting symptom of encephalitis is altered mental status and it can be accompanied by current or recent fever, seizures and focal neurological signs such as ataxia. Altered mental status can include lethargy, drowsiness, confusion, disorientation and coma. Other features of encephalitis can include severe headache, nausea and vomiting, disorientation, speech disturbances and behavioural changes. These symptoms can also be seen in individuals with systemic sepsis without encephalitis. Encephalitis can have an acute onset or run an indolent course.
Long-term central nervous system (CNS) consequences of COVID-19 in children
Published in Expert Review of Neurotherapeutics, 2023
Saskia Howe de la Torre, Valeria Parlatini, Samuele Cortese
Overall, headache, cognitive deficits, anosmia, ageusia, and dizziness appear to be common neurological symptoms associated with long COVID in the pediatric population. Prevalence estimates are highly variable in the literature due to study heterogeneity in terms of design, sample size, inclusion of children with confirmed and non-confirmed infection, severity of primary COVID infection (mild vs severe symptoms requiring hospitalization), and method of case identification (e.g. general population vs specialized long COVID clinics). Pooled prevalence estimates range between 9.7% (fatigue) to 4.4% (dizziness) [19]. Similarly, symptom duration varies across studies and, although symptoms generally improve over time, they have been reported even after several months following initial infection. Increasing age has been identified as a risk factor, as well as female sex for some symptoms (ageusia and dizziness). Seizures typically present as acute SARS-CoV-2 sequela, but long-term risk warrants further investigation. Finally, encephalitis/encephalopathy are rare and often fatal acute complications but may be associated with long-term cognitive/neurological symptoms in survivors.
Rates of Herpes Simplex Virus Types 1 and 2 in Ocular and Peri-ocular Specimens
Published in Ocular Immunology and Inflammation, 2023
Descriptions of HSV-2 ocular disease in the medical literature are primarily limited to case reports/series. Reports describing patients with active genital disease preceding ocular infection have suggested transmission from the genital site to the eye.6 In the two cases of ARN presented here, patients presumably developed an intrauterine or peripartum HSV-2 infection which manifested as neonatal encephalitis and then remained dormant for many years until recurring as ocular disease. Specific mutations and abnormalities of the innate immune system may increase the susceptibility to HSV encephalitis,7 although it is unknown whether any genetic predisposition was involved in these cases. Cases of presumed recrudescence of latent HSV-2 have been reported in patients with previous perinatal infections. However, in some reported cases, there was ocular trauma that occurred 2–3 weeks prior to the retinitis resulting in trauma-induced reactivation of latent virus.8,9 In addition to trauma as a risk factor for recurrence, both systemic and subconjunctival corticosteroid administration prior to development of ARN have been reported.9,10 In the cases presented here, there was no history of preceding trauma or corticosteroid exposure, suggesting spontaneous reactivation. Cases of ARN in children or neonates with concurrent or preceding extra-ocular HSV-2 have also been reported.11,12
Bilateral Necrotizing Retinitis following Encephalitis Caused by the Pseudorabies Virus Confirmed by Next-Generation Sequencing
Published in Ocular Immunology and Inflammation, 2021
Feng Hu, Jiawei Wang, Xiao-Yan Peng
NGS has been used to detect unexpected pathogens in intraocular fluid in recent years, which has high sensitivity and specificity.9 In this case, the pathogen diagnosis for retinitis was confirmed by detection of PRV in the vitreous specimen. In addition, NGS was negative for PRV in the CSF. In PRV encephalitis patients with ocular involvement, intraocular fluid NGS provides more options and longer time windows for pathogenic detection. The diagnosis of encephalitis was supported by the clinical presentation, CSF tests, and head MRI exams. Additionally, the acute attack and rapid progression of headache, seizure, alternation of consciousness in this case were consistent with reported PRV encephalitis. Requiring ventilator support was also common in PRV encephalitis.1