ABSTRACT
AIM: Paucity of studies on neurological manifestations in dengue virus infection prompted this study. We aim to correlate clinical, radiological and neurophysiological changes in dengue patients with neurological manifestations. METHOD: Consecutive IgM seropositive dengue patients admitted in neurology ward during 2003-2005 have been prospectively evaluated. They were subjected to detailed clinical evaluation, blood counts, coagulation profile, serum chemistry including creatine kinase (CK), cerebrospinal fluid (CSF), cranial CT and/or MRI, electroencephalogram (EEG), nerve conduction and needle electromyography (EMG). RESULTS: There were 17 patients, aged 5 to 56 years; 11 presented with encephalopathy and 6 with acute motor weakness. In the patients with encephalopathy, seizures were present in 3, myoclonus in 1, CSF pleocytosis and EEG slowing in 8 each and globus pallidus and thoracic spinal cord involvement on MRI in 1 patient each. In the pure motor weakness group, CK was elevated in 5 and EMG and muscle biopsy were consistent with myositis in 1 patient each. The patients with pure motor weakness improved completely but in the encephalopathy group 3 died, 2 had partial, 1 poor and 5 complete recovery by 1 month. CONCLUSION: Dengue patients presenting with encephalopathy had more severe illness and worse outcome compared to acute pure motor weakness.
Subject(s)
Brain Diseases, Metabolic/virology , Central Nervous System/physiopathology , Dengue/complications , Encephalitis, Viral/physiopathology , Encephalitis, Viral/virology , Adolescent , Adult , Aged , Brain Diseases, Metabolic/diagnosis , Brain Diseases, Metabolic/physiopathology , Central Nervous System/pathology , Central Nervous System/virology , Child , Child, Preschool , Creatine Kinase/blood , Electroencephalography , Encephalitis, Viral/diagnosis , Female , Globus Pallidus/pathology , Globus Pallidus/physiopathology , Globus Pallidus/virology , Humans , Leukocytosis/diagnosis , Leukocytosis/physiopathology , Leukocytosis/virology , Magnetic Resonance Imaging , Male , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/physiopathology , Muscle Weakness/virology , Myoclonus/diagnosis , Myoclonus/physiopathology , Myoclonus/virology , Myositis/complications , Myositis/physiopathology , Myositis/virology , Prospective Studies , Seizures/diagnosis , Seizures/physiopathology , Seizures/virology , Spinal Cord/pathology , Spinal Cord/physiopathology , Spinal Cord/virologyABSTRACT
We report a case of hemorrhagic shock and encephalopathy in a child with pandemic 2009 H1N1 influenza infection. The patient succumbed within 3 days of admission.
Subject(s)
Acidosis/physiopathology , Brain Diseases, Metabolic/physiopathology , Encephalitis/physiopathology , Fever/physiopathology , Influenza A Virus, H1N1 Subtype/immunology , Influenza, Human/physiopathology , Shock, Hemorrhagic/physiopathology , Acidosis/complications , Acidosis/immunology , Acidosis/virology , Brain Diseases, Metabolic/complications , Brain Diseases, Metabolic/immunology , Brain Diseases, Metabolic/virology , Child, Preschool , Cytokines/analysis , Cytokines/immunology , Encephalitis/complications , Encephalitis/immunology , Encephalitis/virology , Fatal Outcome , Fever/complications , Fever/immunology , Fever/virology , Hong Kong , Hospitalization , Humans , Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza, Human/complications , Influenza, Human/immunology , Influenza, Human/virology , Male , Shock, Hemorrhagic/complications , Shock, Hemorrhagic/immunology , Shock, Hemorrhagic/virology , SyndromeABSTRACT
Three children developed severe encephalopathy associated with human herpesvirus 6 infection. Magnetic resonance imaging of the brain showed either basal ganglia involvement or diffusion abnormalities in the cerebral white matter. Coagulopathy with hypercytokinemia was observed in 2 patients. One demonstrated thermolabile variation in carnitine palmitoyltransferase 2. These results suggest a heterogeneous pathogenic mechanism in encephalopathy associated with human herpesvirus 6 infection.
Subject(s)
Basal Ganglia/physiopathology , Brain Diseases, Metabolic/physiopathology , Disseminated Intravascular Coagulation/physiopathology , Encephalitis, Viral/physiopathology , Neurotoxicity Syndromes/physiopathology , Roseolovirus Infections/physiopathology , Basal Ganglia/enzymology , Basal Ganglia/immunology , Basal Ganglia/virology , Biomarkers/blood , Brain Diseases, Metabolic/blood , Brain Diseases, Metabolic/complications , Brain Diseases, Metabolic/immunology , Brain Diseases, Metabolic/virology , Carnitine O-Palmitoyltransferase/blood , Child, Preschool , Cytokines/blood , Cytokines/immunology , Disseminated Intravascular Coagulation/blood , Disseminated Intravascular Coagulation/complications , Disseminated Intravascular Coagulation/immunology , Disseminated Intravascular Coagulation/virology , Electroencephalography , Encephalitis, Viral/blood , Encephalitis, Viral/complications , Encephalitis, Viral/immunology , Encephalitis, Viral/virology , Female , Herpesvirus 6, Human , Humans , Infant , Japan , Magnetic Resonance Imaging , Neurotoxicity Syndromes/blood , Neurotoxicity Syndromes/complications , Neurotoxicity Syndromes/immunology , Neurotoxicity Syndromes/virology , Polymerase Chain Reaction , Roseolovirus Infections/blood , Roseolovirus Infections/complications , Roseolovirus Infections/immunology , Roseolovirus Infections/virology , Th1-Th2 BalanceABSTRACT
We first report sisters presenting with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS)-like features, i.e., mild and reversible neurological manifestations, and MRI finding of a reversible lesion with transiently reduced diffusion in the corpus callosum associated with symmetrical white matter. The distributions of the white matter lesions (more extensive) and Na levels (normal) were different from those reported for sporadic MERS patients (subcortical white matter close to the central sulci, and hyponatremia), which suggested that the pathophysiology of the sisters with MERS-like features might be different from that of sporadic MERS. Some genetic factors might be involved in MERS, especially in some patients with extensive white matter lesions.
Subject(s)
Adenoviridae Infections/complications , Brain Diseases, Metabolic/pathology , Corpus Callosum/pathology , Encephalitis/pathology , Siblings , Asian People , Brain/pathology , Brain/physiopathology , Brain Diseases, Metabolic/genetics , Brain Diseases, Metabolic/virology , Brain Edema/metabolism , Brain Edema/physiopathology , Child , Child, Preschool , Corpus Callosum/physiopathology , Diffusion Magnetic Resonance Imaging , Encephalitis/genetics , Encephalitis/virology , Female , Genetic Predisposition to Disease/genetics , Humans , Inheritance Patterns/genetics , Japan , Nerve Fibers, Myelinated/metabolism , Nerve Fibers, Myelinated/pathology , Syndrome , Water-Electrolyte BalanceABSTRACT
There is growing evidence that hepatitis C virus (HCV)-infection may affect the brain. About half of the HCV-infected patients complain of chronic fatigue irrespective of their stage of liver disease or virus replication rate. Even after successful antiviral therapy fatigue persists in about one third of the patients. Many patients, in addition, report of deficits in attention, concentration and memory, some also of depression. Psychometric testing revealed deficits in attention and verbal learning ability as characteristic for HCV-afflicted patients with normal liver function. Magnetic resonance spectroscopic studies showed alterations of the cerebral choline, N-acetyl-aspartate, and creatine content in the basal ganglia, white matter and frontal cortex, respectively. Recently, pathologic cerebral serotonin and dopamine transporter binding and regional alterations of the cerebral glucose utilisation compatible with alterations of the dopaminergic attentional system were observed. Several studies detected HCV in brain samples or cerebro-spinal fluid. Interestingly, viral sequences in the brain often differed from those in the liver, but were closely related to those found in lymphoid tissue. Therefore, the Trojan horse hypothesis emerged: HCV-infected mononuclear blood cells enter the brain, enabling the virus to reside within the brain (probably in microglia) and to infect brain cells, especially astrocytes.
Subject(s)
Brain/metabolism , Brain/physiopathology , Encephalitis, Viral/metabolism , Encephalitis, Viral/physiopathology , Hepatitis C/complications , Astrocytes/virology , Brain/virology , Brain Diseases, Metabolic/metabolism , Brain Diseases, Metabolic/physiopathology , Brain Diseases, Metabolic/virology , Chemotaxis, Leukocyte/physiology , Encephalitis, Viral/virology , Hepacivirus/physiology , Humans , Leukocytes, Mononuclear/virology , Microglia/virologyABSTRACT
An 8-year-old female presented with a distinct clinical course characterized by an acute self-limiting chorea-encephalopathy with cerebrospinal fluid (CSF)-specific oligoclonal bands. During the clinical course, genomic human parvovirus B19 DNA was detected in her serum and CSF. It was concluded that this patient represents the first published case of childhood chorea-encephalopathy associated with, and probably caused by, human parvovirus B19 infection.
Subject(s)
Brain Diseases, Metabolic/virology , Chorea/virology , Parvoviridae Infections/complications , Parvovirus B19, Human/isolation & purification , Brain Diseases, Metabolic/immunology , Child , Chorea/immunology , Disease Progression , Female , Humans , Immunoglobulin G/immunology , Immunoglobulin M/immunology , Parvoviridae Infections/diagnosis , Parvoviridae Infections/immunology , Polymerase Chain Reaction , Time FactorsABSTRACT
OBJECTIVE: To describe differing etiologies and possible anatomoclinical correlates of choreic movements in a series of AIDS patients. METHODS: We analyzed the clinical records and neuroimaging data of 5 consecutive AIDS patients who developed choreic movements at our center from January, 1994 to December, 1996. RESULTS: There were 2 cases of focal choreic dyskinesias, 1 of right hemichorea, and 2 of generalized chorea. Onset was acute and febrile in 1 case, and subacute in the other 4. In 1 patient the chorea was the AIDS onset symptom; in another choreic movements were the first neurological symptom following AIDS diagnosis; in 2 patients AIDS had a neurological onset other than chorea; and in the fifth patient buccofacial dyskinesias appeared following the development of bacterial encephalitis. CONCLUSION: Chorea was associated with cerebral toxoplasmosis in 2 patients, progressive multifocal leukoencephalopathy in 1, subacute HIV encephalopathy in another, and was probably iatrogenic in the last. Chorea is not unusual in AIDS, however the causes are variable and careful neuroradiological and clinical evaluation is required to identify them. AIDS-related disease should be considered in young patients presenting with chorea without a family history of movement disorders.