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Related Experiment Videos

[Herpetic simplex encephalitis followed by myelopathy]

K Nakamura1, T Terasaki, T Tsuchiya

  • 1Department of Medicine, National Cardiovascular Center, Osaka, Japan.

No to Shinkei = Brain and Nerve
|June 1, 1993
PubMed
Summary

Herpetic encephalitis, caused by herpes simplex virus (HSV), can affect the brainstem and cerebellum. This case highlights potential spinal cord involvement and the importance of timely diagnosis and treatment for neurological recovery.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Neuroimmunology

Background:

  • Herpetic encephalitis is a severe neurological condition often caused by herpes simplex virus (HSV).
  • Early diagnosis and treatment are crucial for improving patient outcomes.
  • Understanding the full spectrum of neurological involvement is essential for comprehensive patient care.

Observation:

  • A 48-year-old male presented with fever, headache, vomiting, altered consciousness, and neurological deficits including ataxia and myoclonus.
  • Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, elevated protein, and decreased glucose, with elevated herpes simplex virus (HSV) IgG antibodies.
  • Magnetic resonance imaging (MRI) showed lesions in the cerebellum, supratentorial white matter, and brainstem, consistent with herpetic encephalitis.

Findings:

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  • The patient was diagnosed with herpetic encephalitis involving the brainstem and cerebellum, treated with acyclovir.
  • Despite initial recovery, the patient developed paraplegia and sensory disturbances, indicating spinal cord involvement.
  • Detection of oligoclonal IgG bands in CSF during the convalescent stage suggests a potential post-infectious or autoimmune process.

Implications:

  • This case underscores the potential for herpetic encephalitis to cause widespread central nervous system (CNS) and spinal cord inflammation.
  • The presence of oligoclonal bands may indicate an immune-mediated component contributing to neurological damage.
  • Further research is needed to elucidate the mechanisms of spinal cord involvement in herpetic encephalitis and optimize treatment strategies.