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Related Experiment Videos

[Chronic herpes simplex encephalitis initially presenting with persistent myoclonus]

M Urushitani1, H Wakita, A Ikeda

  • 1Department of Neurology, Kyoto University Hospital.

Rinsho Shinkeigaku = Clinical Neurology
|August 1, 1993
PubMed
Summary
This summary is machine-generated.

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Atypical chronic herpes simplex encephalitis presented with brainstem symptoms and myoclonus. High-dose acyclovir treatment was effective, revealing cortical origin of myoclonus despite brainstem lesions.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Neurovirology

Background:

  • Herpes simplex encephalitis (HSE) is a severe neurological condition.
  • Chronic forms of HSE are rare and can present atypically.
  • Early diagnosis and treatment are crucial for patient outcomes.

Observation:

  • A 59-year-old female presented with myoclonus, gaze palsy, ataxia, and brainstem dysfunction.
  • Cerebrospinal fluid analysis confirmed herpes simplex virus type I (HSV-1) infection.
  • MRI revealed brainstem lesions, while initial EEG was normal, later showing diffuse slow waves.

Findings:

  • High-dose acyclovir (1200 mg/day) effectively treated myoclonus and consciousness disturbance.
  • Somatosensory evoked potentials (SEP) showed enlarged amplitude (giant SEP) and enhanced C-reflex, indicating cortical origin of myoclonus.

Related Experiment Videos

  • Brainstem inflammation likely disinhibited the cortical sensorimotor area, leading to cortical myoclonus.

    • Implications:

    • This case highlights the importance of considering atypical presentations of chronic HSE.
    • Understanding the pathophysiology of myoclonus in HSE is critical for targeted treatment.
    • Effective management with acyclovir underscores its role in treating HSV-1 neurological infections.