Acute measles encephalitis of the delayed type.

An acute measles encephalitis with epilepsia partialis continua occurred three months after measles in a previously healthy child with no detectable immunological defect. Levels of measles antibodies in serum and cerebrospinal fluid were high, and tubular inclusions of the type seen in subacute sclerosing panencephalitis were found in nerve cell nuclei. A communicating high-pressure hydrocephalus developed in the later stage of the disease. This case demonstrates that measles encephalitis of the delayed type should systematically be considered in children with acute encephalitis.     

Neurologic outcome of acute measles encephalitis according to the MRI patterns

The aim of this prospective study was to clarify the ramifications of neuroimaging patterns associated with neurologic outcomes of acute measles encephalitis. Twelve patients with neurologic complications stemming from a measles outbreak were diagnosed based on characteristic clinical features, the presence of measles-specific antibodies, and abnormal cerebrospinal fluid findings. Neuroimaging studies were then performed during the acute phase of the disease.Our subject group consisted of four males and eight females (mean age: 9.9 years). Main neurologic findings were loss of consciousness, seizures, and paralysis. Serum tests for measles-specific Ig G and M antibodies were positive in eleven patients. Neuroimages of the group revealed the following three abnormalities: (1). demyelination of white matter with hypoperfusion on interictal single-photon-emission computed tomography, (2). high signal intensity of gray matter with hypoperfusion on interictal single-photon-emission computed tomography, and (3). normal MRI with hypoperfusion on single-photon-emission computed tomography.We identified a new pattern of acute measles encephalitis that involved cortical and/or deep gray matter, and this finding suggests a variant in the pathogenesis of acute measles encephalitis. Patients that demonstrated a gray matter abnormality had a higher rate of complications and required longer periods of hospitalization.     

Long-term persistence of intrathecal virus-specific antibody responses after herpes simplex virus encephalitis

Summary Paired sera and cerebrospinal fluids (CSF) from nine surviving patients were collected 4.5 to 8 years after acute herpes simplex (HS) virus encephalitis. Oligoclonal bands of IgG were detected in the CSF of all, and seven patients had an elevated CSF IgG index. Antibodies to HS, varicella-zoster (VZ), measles, and cytomegalo viruses were analysed by enzyme-linked immunosorbent assay (ELISA) and by imprint immunofixation (IIF) of specimens separated by electrophoresis and by thin-layer electrofocusing. Intrathecal synthesis of HS and VZ IgG antibodies was demonstrated in all and of measles IgG antibodies in one patient by both methods. Intrathecal synthesis of HS IgA antibodies was demonstrated by ELISA in three and by IIF in seven patients; the latter method also disclosed intrathecal synthesis of VZ IgA antibodies in two. No patient had intrathecal synthesis of viral IgM antibodies. The intrathecally synthesized antibodies demonstrated by IIF displayed oligoclonal characteristics. The IIF analyses as well as virus absorption tests indicated that the intrathecally synthesized VZ IgG and IgA antibodies could be explained as HS antibodies cross-reacting with VZV. The results indicate that a long-term persistence of intrathecal antibody reesponses to HS virus is a common feature after acute HS encephalitis. The intrathecal production of measles IgG antibodies in one case may reflect a similar persistence of non-specific immune responses induced during the acute infection.     

Measles vaccination does not prevent multiple sclerosis

Twenty-seven young patients with multiple sclerosis (MS) were studied to determine if they had received prior measles vaccination. Fourteen patients whose immunization records were available had received measles vaccine in childhood. Eight other patients gave a history of receiving measles vaccine. These results suggest that infection by measles virus is probably not the sole cause of MS and that, unlike subacute sclerosing panencephalitis and postmeasles encephalitis, MS may not be preventable by measles vaccination given at an appropriate age.     

Acute encephalitis with intrathecal synthesis of measles antibodies

Summary In two cases of acute encephalitis, there was an intrathecal antibody synthesis against measles virus, as determined with an enzyme-linked immunosorbent assay. The clinical findings were not consistent with a usual measles infection, subacute sclerosing panencephalitis or acute multiple sclerosis.     

A case of acute measles encephalitis with periodic synchronous discharge on electroencephalography]

A 18-year-old man was diagnosed as having measles on the basis of cutaneous and mucosal eruption and high grade fever on May 10, 2001. Six days after the skin eruption, the patient developed general convulsion (day1). He was admitted to our hospital because of status epilepticus. We made a diagnosis of acute measles encephalitis, based on the clinical features and pleocytosis with an increase in protein in the cerebrospinal fluid. Under artificial ventilation and sedation, he received intravenous immunoglobulin and dexamethasone. Electroencephalography (EEG) on day 4 revealed periodic synchronous discharge (PSD). Significant elevation of antibody titer for measles virus was found in the serum, but not in the cerebrospinal fluid. Polymerase chain reaction method did not show viral genes of measles virus, herpes simplex virus and herpes zoster virus. Serial EEG studies demonstrated a decrease in PSD, followed by irregular spike-wave complexes within 20 days. He recovered completely one month after the onset. It should be kept in mind that PSD can emerge on EEG in the early stage of acute measles encephalitis.     

Encéphalite alguë retardée de la rougeole

The authors report two new cases of measles encephalitis of the delayed type and compare their clinical and biological characteristics with those of post-eruptive encephalitis and subacute sclerosing panencephalitis. They emphasize the need to look for the encephalitis of the delayed type in all case of acute encephalitis in children. A comparative study of CSF/serum antibody ratios for different viruses is helpful in establishing the etiological diagnosis.     

Encephalitis after inhalation of measles virus: A pathogenetic study in hamsters

A neuroadapted strain of measles virus (HNT) was administered by inhalation to newborn hamsters. Primary replication of virus in the lung was followed by the transient appearance of virus in spleen within 7 to 9 days of inoculation. A terminal encephalitis occurred between 6 and 60 days in 31% of infecfted hamsters, and virus was recovered by explant culture of these brains. Virus could not be cultured directly from brain or tissue homogenates. At least 7% of hamsters that had survived the infection for two months had antibody to measles virus. The histopathological change in morbid animals was limited to the central nervous system (CNS) and consisted of small foci of necrosis, perivascular mononuclear cell infiltrates, intracytoplasmic and intranuclear inclusions, and vacuolated pyknotic neurons. Immunofluorescent studies disclosed measles antigen in the lungs and brain. This hamster moENl of measles encephalitis following a “natural” route of inoculation appears to represent a faithful reproduction of certain CNS complications of natural measles infection in humans, i.e., measles encephalitis and subacute sclerosing panencephalitis.     

Intrathecal synthesis of different alpha-interferons in patients with various neurological diseases

CSF and sera from 238 newborns and children with various neurological diseases were assayed on bovine cells for the presence of alpha-interferon (IFN). An intrathecal synthesis of pH 2-resistant alpha-IFN was recovered in all newborns and in more than 90% of children with herpes encephalitis. It was also observed in one case of mumps encephalitis and in one case of encephalitis associated with Influenza A infection. An acid-labile alpha-IFN production was detected in CSF from more than one half of patients with viral meningitis or active congenital rubella and in those with neurological complications of systemic lupus erythematosus. This alpha-IFN subtype was also detected in CSF from only 2/37 children with measles encephalitis. In contrast, no alpha-IFN (less than 2 IU) in CSF was found among patients with subacute sclerosing panencephalitis, Guillain-Barré syndrome, Reye's syndrome, acute cerebellar ataxia, infantile spasms or facial paralysis of unknown origin.     

Measles virus and associated central nervous system sequelae

Worldwide, measles remains one of the most deadly vaccine-preventable diseases. In the United States, enrollment in the public schools requires that each child receives 2 doses of measles-containing vaccine before entry, essentially eliminating this once endemic disease. Recent outbreaks of measles in the United States have been associated with importation of measles virus from other countries and subsequent transmission to intentionally undervaccinated children. The central nervous system complications of measles can occur within days or years of acute infection and are often severe. These include primary measles encephalitis, acute postinfectious measles encephalomyelitis, measles inclusion body encephalitis, and subacute sclerosing panencephalitis. These measles-associated central nervous system diseases differ in their pathogenesis and pathologic effects. However, all involve complex brain-virus-immune system interactions, and all can lead to severe and permanent brain injury. Despite better understanding of the clinical presentations and pathogenesis of these illnesses, effective treatments remain elusive.     

Distribution of measles virus in the central nervous system of HIV-seropositive children

In an autopsy study the distribution of measles virus (MV) in the central nervous system (CNS) of 18 measles-infected children (13 HIV seropositive, 5 HIV seronegative), in Abidjan, Ivory Coast was examined using immunocytochemistry and in situ hybridization. Of these children 17 died from measles giant cell pneumonia. In 3 of the 13 HIV-seropositive patients MV antigens and genomic RNA was detected in the CNS. One of these positive patients had an MV encephalitis with abundant virus throughout most of the CNS. MV was not detected in the CNS of any of the 5 HIV-seronegative patients. These findings, albeit in a small number of cases, would suggest there may be an increased susceptibility to infection of the CNS with MV in HIV-positive children. In this respect entry and growth of MV in the CNS in HIV-seropositive individuals may be similar to the occurrence of measles inclusion body encephalitis in immunocompromised individuals. Furthermore, comparison of the HIV-MV encephalitis patient with two patients with subacute sclerosing panencephalitis (SSPE) demonstrated a paucity of virus in neuronal processes in the HIV-MV encephalitis. Unlike in SSPE, MV maturation by budding through the plasma membrane may occur, thereby minimizing build up of and intracellular movement of incomplete virus. Received: 6 March 1998 / Revised, accepted: 2 June 1998     

Movement disorders in adult-onset measles encephalitis

There are three different neurological complications of measles infections in the brain: acute postinfectious encephalitis, acute progressive infectious encephalitis, and subacute sclerosing panencephalitis. The diagnosis of measles encephalitis (ME) is established when supported by the clinical picture, mainly of juvenile onset, and confirmed by the presence of cerebrospinal measles antibodies. Although ME is clinically characterized by progressive behavioral and mental deterioration associated with myoclonus, prior reports have suggested that adult-onset may have atypical features. We describe a 28 year-old immunocompetent man, admitted into the hospital due to a rapid motor and cognitive decline after an episode of fever and gastroenteritis. His neurological examination was significant for cognitive impairment, cervical dystonia, spontaneous and action induced myoclonus, choreiform movements, parkinsonism and ataxic gait. He was diagnosed of acute postinfectious ME based on the presence of elevated intrathecal synthesis of measles antibodies in his CSF, and a lymphocytic infiltrate of perivascular distribution without viral inclusions, with PCR negative for measles from brain biopsy. The patient continued to deteriorate to an akinetic mutism state, dying a few weeks later. Adult-onset ME is an entity rarely seen in the Western world. Although myoclonus is the most common movement disorder related to juvenile-onset ME, ataxia and other dyskinesias such as chorea, dystonia, and parkinsonism, can result from this infection when presenting in adult life.     

Atypical subacute sclerosing panencephalitis

Summary An unusual case of panencephalitis in a 4-year-old Japanese boy, with onset at three months after measles infection and rapid progression to a comatose state in approximately one month, is described. A rapid rise in serum measles antibody titre after the onset of the symptoms, and the appearance of various abnormal antibodies in the serum, were noted. Pathologically, the brain showed sclerosing polio- and leucoencephalitis with diffuse gliosis and sporadic intranuclear inclusions. The process is suggested to be intermediate or transitional between acute measles encephalitis and SSPE.     

Treatment of disturbances of consciousness caused by measles encephalitis with levodopa.

Results are reported of a double-blind trial with L-dopa in 39 patients with measles encephalitis. In this treatment series, L-dopa improved the state of awareness and the diffuse disturbances in the EEG. There was a significant difference too, regarding the outcome between patients treated with L-dopa and placebo. The death rate in the L-dopa-treated group was lower and there were fewer mental sequelae. It is suggested, that L-dopa should be used in patients with measles encephalitis.     

抗NMDAR脑炎临床特点及影像表现分析

目的 探讨抗NMDAR脑炎的临床特点、影像表现及意义.方法 回顾性分析陕西省人医院2014-01—2020-08确诊的11例抗NMDAR脑炎患者的临床及影像资料.结果 11例患者为急性或亚急性起病,首发症状表现为精神症状2例,认知功能损害2例,痫性发作4例,非特异性症状3例.11例患者的脑脊液抗NMDAR抗体均为阳性,...     

Protracted mumps encephalitis with good outcome

There is limited published information regarding the outcome of patients with prolonged encephalitis. This report details the case of a patient with an encephalitic illness with a protracted period of coma and a favourable outcome. Extensive investigation revealed seroconversion for mumps infection. A household contact had measles, mumps, rubella (MMR) vaccination 10 days prior to his presentation.     

Encephalitis Lethargica-like Illness in a Five-year-old

A five-year-old boy presented with an encephalitis lethargica-like illness, characterised by somnolence, mutism and Parkinsonian rigidity two weeks after an acute exanthem. Investigation revealed increased serum measles antibody titre. He made a complete recovery. Encephalitis lethargica associated with Parkinsonism in childhood is rare and usually carries a poor prognosis.     

Meningoencephalitis in the acute phase of measles. Report of 6 cases

We present the clinical and laboratory manifestations of encephalitis following measles in six patients which were diagnosed during the epidemics that occurred in the city of S?o Paulo, Brazil, in 1997. We performed retrospective case analysis of the six patients diagnosed as having encephalitis due to measles. Encephalitis was diagnosed based on clinical grounds and on the cerebrospinal fluid (CSF) alterations. All the cases were serologically confirmed. Of 467 patients with measles who presented themselves for medical care at the Instituto de Infectologia Emílio Ribas six were diagnosed with encephalitis. Patient's age was 2 months to 28 years old. The most frequent symptoms were drowsiness and nuchal rigidity. CSF showed an increased of white cell count in all cases. Four patients were admitted to the intensive care unit. Two of them required mechanical ventilation. In only two patients did the computerized tomography show abnormalities. All showed good recovery without sequelae.     

Viral encephalitis and epilepsy

Viral encephalitis presents with seizures not only in the acute stage but also increases the risk of late unprovoked seizures and epilepsy. Acute symptomatic and late unprovoked seizures in different viral encephalitides are reviewed here. Among the sporadic viral encephalitides, Herpes simplex encephalitis (HSE) is perhaps most frequently associated with epilepsy, which may often be severe. Seizures may be the presenting feature in 50% patients with HSE because of involvement of the highly epileptogenic frontotemporal cortex. The occurrence of seizures in HSE is associated with poor prognosis. In addition, chronic and relapsing forms of HSE have been described and these may be associated with antiepileptic drug-resistant seizures. Among the epidemic (usually due to flaviviruses) viral encephalitides, Japanese encephalitis (JE) is most common and is associated with acute symptomatic seizures, especially in children. The reported frequency of acute symptomatic seizures in JE is 7–46%. Encephalitis due to other flaviviruses such as equine, St. Louis, and West Nile viruses may also manifest with acute symptomatic seizures. In Nipah virus encephalitis, seizures are more common in relapsed and late-onset encephalitis in comparison to acute encephalitis (4% vs. 1.8%). Other viruses like measles, varicella, mumps, influenza, and entero-viruses may cause seizures depending on the area of brain involved. There is no comprehensive data regarding late unprovoked seizures in different viral encephalitides. Prospective studies are required to document the risk of late unprovoked seizures and epilepsy following viral encephalitis due to different viruses as well as to determine the clinical characteristics, course, and outcome of post-encephalitic epilepsy.