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Published on: July 10, 2011
Human herpesvirus 6 limbic encephalitis after stem cell transplantation
M S Wainwright1, P L Martin, R P Morse
1Division of Pediatric Neurology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL, USA.
Annals of Neurology
|November 15, 2001
Summary
Central nervous system complications after stem cell transplants can manifest as unusual medial temporal lobe involvement. Human herpesvirus 6 (HHV-6) is implicated in this syndrome, characterized by memory loss and seizures.
Area of Science:
- Neuroscience
- Infectious Disease
- Transplantation Medicine
Background:
- Central nervous system (CNS) complications are frequent in stem cell transplant (SCT) recipients.
- Selective medial temporal lobe involvement is an uncommon presentation.
Observation:
- Five SCT recipients developed short-term memory loss, insomnia, and temporal lobe seizures.
- Magnetic resonance imaging (MRI) showed increased hippocampal T2 signal.
- [F-18]fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed increased hippocampal glucose uptake.
Findings:
- Initial electroencephalograms (EEGs) missed subcortical seizure activity, later detected by extended monitoring.
- Cerebrospinal fluid (CSF) analysis detected human herpesvirus 6 (HHV-6) variant B DNA in all tested patients.
- Hippocampal sclerosis was suspected based on follow-up MRI and postmortem findings.
Implications:
- This HHV-6-associated syndrome may be underdiagnosed due to subtle clinical symptoms.
- Diagnosis requires advanced neuroimaging (MRI, FDG-PET), prolonged EEG monitoring, and CSF viral studies.
- Understanding this complication is crucial for managing SCT recipients.
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