Neuroviral Infections and Immunity
Sunit K. Singh, Daniel Růžek in Neuroviral Infections, 2013
Viral infection of the brain frequently results in development of severe disease including meningitis or encephalitis. Once disease has developed, there are few therapeutic interventions available for most viral infections. Subsequently, recovery from neuroviral infections is largely dependent upon supportive medical care and the host immune response. However, this response can come at a cost, including long-term sequelae, which are the result of neuronal damage associated with viral clearance. The intent of this chapter is to provide a broad overview of the host responses to neuroviral infection and the associated mechanisms of viral clearance. We will not focus on specific viruses but will examine general humoral, cell-mediated, and innate responses to viral infection that may contribute to development and resolution of disease with a particular emphasis on acute disease rather than chronic disease. We will also discuss the importance of the blood—brain barrier (BBB) in the regulation of the host response to neural infections.
Varicella-zoster virus
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward in Case Studies in Infectious Disease, 2010
Complications of chickenpox are unusual, especially in an immunocompe-tent child. Secondary bacterial infection of the vesicles may occur, which very occasionally may lead to septicemia, and also may result in scarring once the lesions heal. The disease is much more debilitating in adults, especially smokers, who are also at significant risk of varicella pneumonia, the commonest life-threatening complication. This presents with shortness of breath and cough about 2–3 days after onset of the rash. Encephalitis is uncommon, but may present about 7–10 days after onset. The most likely pathogenesis of this is a post-infectious encephalitis, that is, not due to the presence of virus itself within the brain substance, but arising through aberrant immune responses to infection that damage the brain tissue. A cerebellar syndrome is most often seen in children, but hemiplegia is also described. Recovery is usual, but long-term sequelae and even fatalities may occur.
Accident and Emergency
Nagi Giumma Barakat in Get Through, 2006
This can present at any age, and the presentation varies. Viral infections are the main cause of encephalitis, but metabolic disorders can also be responsible. In viral encephalitis, the presentation can be as acute onset of fever, headache, lethargy, nausea and vomiting. Irritability, off feeding, seizures and lethargy in infants is another presentation. Seizures are common, with some neurological deficit, especially with herpes simplex encephalitis. Fluctuations of symptoms are common, with bizarre behaviour, sleepiness and drowsiness for 10-15 minutes then back to normal. The symptoms can get worse, and the child will lapse into a coma and require ventilatory support. The blood tests are usually normal, and a lumbar puncture is not specific, with few white cells, red cells, normal or low glucose, and normal protein. PCR for HSV and other viruses is now helpful to rule these out. An EEG will show focal abnormalities and temporal lobe discharges as in HSV encephalitis. Enhanced CT may show the focal infected area, and an MRI is more specific. Supportive treatment, antivirals, antibiotics and control of seizures are what the patient needs. Mortality and morbidity with HSV encephalitis is high, but is less with other viruses.
Digital physical therapy practice and payment during the COVID-19 pandemic: A case series
Published in Physiotherapy Theory and Practice, 2023
Patient 2 was a 30-year-old male cook who self-referred to in-person physical therapy with pain in the right suboccipital region that would occasionally turn into a right-sided headache in the parietal region about every 2 days. These headaches would last until he slept that night. This pain impacted his ability to concentrate at work and turn his head when monitoring the kitchen. The neck pain began gradually and was intermittent over the previous 5 months. When the headache first began, he had a fever for 1 day and visited an emergency room. Concerns about encephalitis and meningitis prompted laboratory testing, computed tomography scanning, and MRI scanning of the brain and cervical spine, which all returned normal results. Mild degenerative changes were shown at C6-C7, but the communication related to this relatively normal finding was not adequately explained. Five months later, he continued to have worries about his headache and felt neck stiffness when turning his head. Patient 2 had a history of anxiety. His pain could range from a 1/10 at best to a 9/10 at worst on the NPRS. He denied any visual disturbances, nausea, fever, trauma, or extremity paresthesia.
An unusual presentation of clival chordoma: a case report and review of the literature
Published in British Journal of Neurosurgery, 2020
Monther Andijani, Aimun Jamjoom, Antonia Togersen, Bhashkar Ram, Peter Bodkin, Mahmoud Kamel
A CSF sample had glucose of 4.6 mmol/l, normal protein (169 mg/l), red blood cells (RBC) of 41/micro litre and no white blood cells (WBC). There were no organisms observed in microscopy or grown in culture. The patient was kept sedated post-operatively and started on Levetiracetam. An MRI scan showed an abnormal brain stem appearance, seen better on T2-weighted images, and evidence of inflammation within the para-nasal sinuses, particularly the left sphenoid sinus, with some bony erosions and breach into the posterior fossa (Figure 2). An impression of brainstem encephalitis was made with sinusitis being the probable source infection and the patient was treated with IV antibiotics including metronidazole, ceftriaxone, and amoxicillin as well as acyclovir. A nasoendoscopy was done by the otolaryngology team, which showed some discharge from the sinuses and the patient was started on nasal steroids drops. The patient made a good recovery following extubation and on day 7 post admission he was discharged from ICU to the neurosurgical ward.
Subgingival microbiome at different levels of cognition
Published in Journal of Oral Microbiology, 2023
Nele Fogelholm, Jaakko Leskelä, Muhammed Manzoor, Jacob Holmer, Susanna Paju, Kaija Hiltunen, Hanna-Maria Roitto, Riitta Kt Saarela, Kaisu Pitkälä, Maria Eriksdotter, Kåre Buhlin, Pirkko J Pussinen, Päivi Mäntylä
Although older adults with declining cognition have limited capability to maintain oral hygiene and often develop oral health problems, epidemiological studies have suggested a bi-directional association between oral health and declining cognition/dementia [19,20]. This bidirectional relationship between some neurodegenerative diseases and periodontitis is associated with an increase in inflammatory biomarkers, in IgG related to periodontopathogenic bacteria, and in periodontitis severity [21]. Mild cognitive impairment (MCI) may progress in some people to dementia, but others may remain stable or recover full function [22]. It has been argued based on experimental animal studies that brain infection is an early event much before cognitive decline and diagnosis of dementia [13]. It seems plausible that the oral dysbiosis promoting systemic inflammation may play a role in several of these neurodegenerative diseases [23].
Related Knowledge Centers
- Amnesia
- Confusion
- Fever
- Hallucination
- Inflammation
- Vomiting
- Headache
- Brain
- Neck Stiffness
- Seizure