Herpes simplex virus antigen detection in human acute encephalitis:

Summary The distribution of type I, III, IV and V collagen in 35 gliomas and 20 meningiomas was studied by indirect immmunofluorescence staining. In addition, the presence of fibronectin (FN) and laminin (LN) is also reported. In gliomas expression of type IV collagen and LN was found in the vessel walls and associated with the endothelial glomerulus-like proliferations. FN and type V collagens were located in proliferating vessel walls in a pattern corresponding both to the basement membrane and the perivascular matrix around the vessels. In the extracellular matrix of grade III and IV gliomas occasional faint intercellular fluorescence was also observed with both FN and type V collagen. Type I and III collagens were localised in the vessel walls and in the perivascular connective sheet. Glioma cells did not express any of the antigens investigated. In meningiomas, type IV and V collagens, LN and FN were found in vessel walls, whorls formations and psammoma bodies. These stainings support the hypothesis of a vascular origin of these psammoma bodies which were only found in syncytial and transitional meningiomas. Both type I and III collagens were detected in the perivascular connective tissue. In general, meningioma cells and extracellular matrix did not express any of these molecules, except in transitional meningiomas where occasional fluorescence was observed in extracellular matrix with type V collagen and FN.     

Herpes simplex virus encephalitis complicated by intracerebral hematoma

Herpes simplex virus (HSV) encephalitis complicated by cerebral hematoma is extremely rare. We report a 54-year-old man with hepes simplex encephalitis complicated by intracerebral hematoma and review the literature and describe the characteristics of HSV encephalitis complicated by intracerebral hematoma.     

Herpes simplex virus encephalitis. Neuroanatomical and neurochemical selectivity

Intracerebral infection of mice with HSV-1 was found to produce a 2-3-fold increase in dopamine and serotonin metabolism in cortex, striatum, diencephalon and brain stem. Neurochemical markers of GABA and acetylcholine neurones, and neurotransmitter receptor binding sites were unchanged. The immunohistochemical distribution of virus antigen revealed high levels of immunoreactivity in s. nigra, ventral tegmental area, locus coeruleus and dorsal raphe nucleus, whilst other areas of brain stem were clear of virus antigen. The changes in monoamine metabolism observed in experimental HSV encephalitis may be related to the concentration of virus in monoamine neurones.     

Herpes simplex encephalitis and radiotherapy

A 7-year-old male presented sudden-onset left hemiparesis, left-sided paresthesia, central paralysis of the left VII cranial nerve, and subsequent headache. Magnetic resonance scans were obtained 24 hours after admission. T(2)-weighted images disclosed hyperintensities located mainly in the posterior portion of the lenticular nucleus and in the head and body of the right caudate nucleus. A diagnosis of ischaemic stroke was made on the basis of neuroradiologic findings. Laboratory tests undertaken to establish the cause of stroke revealed parvovirus B19 infection preceding the neurologic abnormalities. In the absence of other known risk factors for stroke the possibility of parvovirus B19's being correlated with stroke onset is discussed.     

Herpes simplex encephalitis with herpes simplex retinitis

The association of herpes simplex encephalitis and herpes simplex retinitis is rare in adults. The case presented indicates that the manifestation of retinitis after herpes simplex encephalitis is infectious and not immunologic in origin. Retinal infection results either from neuron-to-neuron transmission of viruses along the optic nerve or from recurrent viral infection. Treatment with acyclovir improves the otherwise rather poor prognosis of combined herpes simplex encephalitis and retinitis. In this case a second course of systemic treatment with acyclovir was effective.     

Evolution of post-natal Herpes simplex virus encephalitis to multicystic encephalopathy

Summary A 3-week-old, previously healthy infant developed biopsy-proven Herpes virus type 2 (HSV-2) encephalitis. The encephalitis was characterized by cells having intranuclear inclusions and was without evidence of inflammation or hemorrhage. Neuroimaging studies did not show any destructive lesions in the brain. In spite of antiviral therapy, the infant's neurological conditions deteriorated, and the patient died at the age of 18 weeks. Post-mortem examination showed that most of the cerebral hemispheres were replaced by multiloculated cystic cavities of various sizes, typical of multicystic encephalopathy (MCE). The cystic lesions were randomly distributed and were not confined to any vascular territory. By light microscopy, there were no features of viral infection in the brain. Although in situ hybridization of the biopsy specimen taken during the acute phase of the disease demonstrated abundant HSV genome, this same method failed to detect HSV on the post-mortem specimen. These findings suggest that HSV-2 can induce MCE. Furthermore, the absence of histological features of viral encephalitis and the failure to demonstrate viral genome in the brain at autopsy does not exclude an infections etiology in certain cases of MCE.     

Herpes simplex virus encephalitis is a trigger of brain autoimmunity

In 5 prospectively diagnosed patients with relapsing post–herpes simplex encephalitis (HSE), N‐methyl‐D‐aspartate receptor (NMDAR) antibodies were identified. Antibody synthesis started 1 to 4 weeks after HSE, preceding the neurological relapse. Three of 5 patients improved postimmunotherapy, 1 spontaneously, and 1 has started to improve. Two additional patients with NMDAR antibodies, 9 with unknown neuronal surface antibodies, and 1 with NMDAR and unknown antibodies, were identified during retrospective assessment of 34 HSE patients; the frequency of autoantibodies increased over time (serum, p = 0.004; cerebrospinal fluid, p = 0.04). The 3 retrospectively identified NMDAR antibody–positive patients also had evidence of relapsing post‐HSE. Overall, these findings indicate that HSE triggers NMDAR antibodies and potentially other brain autoimmunity. Ann Neurol 2014;75:317–323     

Herpes simplex virus encephalitis: Progression of lesion shown by CT

Summary Computed tomography (CT) of six patients with herpes simplex virus encephalitis (HSVE) showed a deep temporal low attenuation with patchy enhancement after contrast injection in the acute phase of the disease. The involvement progressed in all surviving patients, all of whom were treated with adenine arabinoside.

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Zusammenfassung Bei sechs Patienten mit einer Herpes-Simplex-Virus-Encephalitis (HSVE) wurde im Computer-Tomogramm eine temporo-basale Raumforderung mit erniedrigter Dichte festgestellt, die in der akuten Krankheitsphase nach Kontrastmittelinjektion eine deutliche Anreicherung zeigte. Verlaufs-CT-Untersuchungen ließen bei den überlebenden Patienten eine Größenzunahme der Zone erniedrigter Dichte, diesmal jedoch ohne Kontrastmittelanreicherung, erkennen.

     

Herpes simplex encephalitis in childhood]

Central nervous system (CNS) infection by herpes simplex virus (HSV) in childhood consists of herpes simplex encephalitis and CNS infections in neonates. Herpes simplex encephalitis in children resembles that in adults, but CNS infections in neonates differs from adult herpes simplex encephalitis in pathogenesis and clinical features. Trans-neuronal transmission by HSV type 1 causes herpes simplex encephalitis both in children and adults, while hematogeneous spread by HSV type 1 or type 2 causes CNS infections in neonates. Mortality of CNS infections by HSV in childhood has been improved since early diagnosis by polymerase chain reaction and anti-viral therapies have been established. However, neurological morbidity has not yet been improved and sometimes HSV infections relapse after the acyclovir therapy. Recently, longer acyclovir therapy with larger doses is recommended for the treatment of CNS infections in childhood.     

单纯疱疹病毒性脑炎的无环鸟苷治疗

目的 评价无环鸟苷对单纯疱疹病毒性脑炎的疗效。方法 以46例单纯疱疹病毒性脑炎诸项指标变化来分析无环鸟苷的疗效。结果 无环鸟苷治疗后,本病症状缓解,部分临床检查结果好转,病死率降低。结论 无环鸟苷对本病的疗效显著。