MRI Deterioration in Herpes Simplex Encephalitis Despite Clinical Recovery
Departments of Neurology, University of Ioannina, Greece. The Neurologist
(Impact Factor: 1.16).
08/2009; 15(4):223-6. DOI: 10.1097/NRL.0b013e3181921abc
Herpes simplex virus type 1 is a sporadic cause of viral encephalitis. Relapse of encephalitis occurs in up to 10% of patients, manifested by recurrent symptoms, clinical and MRI findings, and the presence of herpes simplex virus type 1 DNA in the cerebrospinal fluid (CSF).
We describe the clinical features, MRI findings and outcome in 2 patients with herpes simplex encephalitis during the acute phase and 6 months after the onset of encephalitis.
Both patients had a good response to treatment and an excellent recovery. Despite clinical recovery, in a 6-month follow-up MRI lesions consistent with recurrence were disclosed, without any clinical findings or CSF abnormalities.
The mechanism underlying this MRI deterioration is unclear and an immune-mediated mechanism may be involved. Thus, MRI deterioration after herpes simplex encephalitis should be interpreted with caution and it does not always represent a relapse, especially when the imaging studies do not correlate with the clinical and CSF findings.
Available from: Hyun Seok Song
- "Relapse of HSV encephalitis occurs in up to 10%. In relapsing cases, there is clinical deterioration, neuropsychologic deficits, expansion of the lesions in MRI, and presence of viral replication or reactivation in the CSF proven by PCR for HSV type 1 DNA.8 We think in our case, the finding that the follow-up CSF HSV type 1 PCR became negative means it was not the relapse. "
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ABSTRACT: Various neurologic manifestations of herpes simplex virus (HSV) encephalitis have been reported on the literatures. Chorea, ballism, choreoathetosis and myoclonus were reported as movement disorders which might be related with brain lesion by HSV encephalitis, but negative myoclonus (NM) has never been reported before. NM can be characterized as a shock-like involuntary jerky movement caused by a sudden, brief interruption of muscle activity. We experienced a case of HSV encephalitis with NM in unilateral arm and leg. In polygraphic monitoring, electroencephalography (EMG) silent periods are 50-250 ms in duration with no detectable EMG correlate.
Available from: psychiatryonline.org
Available from: George R. Painter
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ABSTRACT: CMX001, an orally active lipid conjugate of cidofovir, is 50 times more active in vitro against herpes simplex virus (HSV) replication than acyclovir or cidofovir. These studies compared the efficacy of CMX001 to acyclovir in BALB/c mice inoculated intranasally with HSV types 1 or 2. CMX001 was effective in reducing mortality using doses of 5 to 1.25 mg/kg administered orally once daily, even when treatments were delayed 48-72 h post viral inoculation. Organ samples obtained from mice treated with CMX001 had titers 3-5 log(10) plaque-forming units per gram of tissue lower than samples obtained from mice treated with acyclovir, including 5 different regions of the brain. Detectable concentrations of drug-related radioactivity were documented in the central nervous system of mice after oral administration of (14)C-CMX001. These studies indicate that CMX001 penetrates the blood-brain barrier, is a potent inhibitor of HSV replication in disseminated infections and central nervous system infections, and is superior to acyclovir.
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