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Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Herpes simplex encephalitis is the most common cause of viral encephalitis. The typical features are bilateral temporal lobe involvement; however this can be asymmetrical, and involvement of the insular cortex, cingulate gyrus and frontal lobes is also common. There is frequently T2 and FLAIR hyperintensity involving the white matter and cortex and low T1 signal due to oedema. Areas of haemorrhage may develop, which will be high on T1 and low on T2 sequences. There is often restricted diffusion and gyral and leptomeningeal enhancement.
Epstein–Barr virus and the nervous system
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Alexandros C. Tselis, Kumar Rajamani, Pratik Bhattacharya
Characteristic symptoms of EBV-associated encephalitis are fever, headache, confusion, seizures, and paresis, as in any other form of viral encephalitis. The encephalitis often occurs in the context of clinical infectious mononucleosis, with fever, sore throat, malaise, and lymphadenopathy, but it can occur without systemic signs [13,17,18,20,21]. Focal features are often seen, and occasionally EBV encephalitis resembles herpes encephalitis [22]. Three cases of brainstem encephalitis have been reported, with one patient recovering completely, one left with mild residual gait ataxia and nystagmus, and one expiring. All three cases were diagnosed by serology [23–25]. Occasionally, the onset of EBV encephalitis is slow and insidious and can consist of behavioral and focal neurological deficits [26]. A few rare cases of the relapsing-remitting disease, satisfying the criteria of multiple sclerosis, following acute EBV infection with neurological manifestations have been described [27]. The relationship between the acute EBV disease and the subsequent MS-like illness is not clear, but recent serological studies have suggested a contributory role of EBV in MS [28]. Acute rapidly fatal encephalitis has been reported in a patent with HIV infection with low CD4 counts and high HIV viral load. The most common presence of EBV infection in the setting of HIV infection is associated with primary CNS lymphoma [29].
The nervous system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Treatment of bacterial CNS infections requires antibiotic therapy. Treatment should not be delayed until a definitive identification of the organism is made, but rather should begin as soon as possible with a broad-spectrum antibiotic with good CNS penetration (i.e., third generation cephalosporin). Treatment of viral encephalitis is mainly supportive and directed at treating any seizures that may occur and preventing increases in intracranial pressure.
Pathogenesis and Management of Acute Necrotizing Encephalopathy
Published in Expert Review of Neurotherapeutics, 2023
Ningxiang Qin, Jing Wang, Xi Peng, Liang Wang
Although many diseases that result from pathogenic infections, such as viral meningitis, are associated with direct pathogen invasion, the notion that viruses directly invade the nervous system and cause ANE is still a topic of debate. Viral encephalitis can be easily confused with acute necrotizing encephalopathy. It is worth mentioning that according to the definition of ANE, there should not be CSF pleocytosis or the presence of a CSF pathogen. These characteristics are typically present in viral encephalitis, which is an important differential diagnosis for ANE. For instance, in the case of COVID−19, this theory suggests that the virus penetrates the brain through the trigeminal nerve and olfactory nerve, causing a series of neurological symptoms. However, Frontera JA et al. [50,51] warned that the PCR tests used to amplify the contaminant could yield a false positive, particularly when the initial CSF test was negative. Stein, SR et al. detected SARS-CoV−2 in brain autopsies, but it is possible that the rough endoplasmic reticulum was misidentified as virions [52]. Despite the fact that ANE can be secondary to various pathogens, the theory that viruses directly invade the nervous system and cause ANE remains controversial. ANE is not regarded as a contagious brain disease, and viral RNA has not been found in the CSF of many ANE patients [5,10,53,54]. Therefore, ANE is unlikely to be caused by direct infection but rather by immune-mediated processes involving proinflammatory cytokines [10,39]. The cases above may represent atypical cases of ANE or viral encephalitis.
Mechanical filtration of the cerebrospinal fluid: procedures, systems, and applications
Published in Expert Review of Medical Devices, 2023
Viral encephalitis (VE) and viral myelitis (VM) are inflammations of the brain and spinal cord respectively, caused by viruses. The virus most commonly involved in CNS infections is herpes simplex virus, but other viruses of the herpesviridae family (e.g. varicella-zoster or Epstein–Barr), along with enterovirus, mumps, measles, and viruses associated with respiratory tract infections (adenovirus and influenza B), varicella-zoster virus, rubella, measles, VIH, JC, and SARS-CoV-2 may also cause VE or VM. VM and VE may present with a variety of syndromes depending on the precise location of the inflammatory focus including rapidly progressive encephalopathy. Some cases develop an increase in ICP, seizures, and depression of the level of consciousness, which requires tracheal intubation for airway protection and ventilatory support, control of raised ICP, and the effective treatment of seizures [16]. Treatment options include medication to relieve the symptoms and antiviral medications for some particular types of viruses (few antivirals are indicated and just some types of viruses, i.e. herpesvirus). More antivirals and adjunctive therapies are needed for better outcomes of VE and VM. To our knowledge, the only case with VE/VM treated with CSF filtration to date is a patient with psychotic symptoms related to Borna disease VE with rapid clinical improvement after CSF filtration [17].
Clinical Spectrum of Uveitis Induced by Herpes Simplex Virus with Posterior Pole Involvement at Initial Presentation: A Case Series and Literature Review
Published in Ocular Immunology and Inflammation, 2022
Feng Hu, Haicheng She, Xusheng Cao, Jiawei Wang, Caixia Lin, Xiaoyan Peng
A 69-year-old man presented to our clinic with blurred visuals in the left eye for 3 weeks, and blurry visuals in the right eye for 1 week. The patient had been diagnosed with viral encephalitis 1 month ago. He denied prior ocular disease history. Upon initial examination, his visual acuity was 20/250 OD and no light perception OS, and his intraocular pressure was within the normal range in both eyes. An anterior segment examination of both eyes revealed fine keratic precipitates, with 1+ flare in the anterior chamber. The pupil in the left eye was dilated and fixed with a diameter of 5 mm; meanwhile, the direct pupil light reflex for the right eye was flexible. Ophthalmoscope examinations revealed severe vitritis and hemorrhage in the left eye, and moderate vitritis in the right eye. Fundus examination findings for the right eye were unremarkable, with no retinal hemorrhage or necrotic lesions (Figure 3A). A retinal examination of the left eye showed the presence of a notable arterial sheath (Figure 3B).