RESUMO
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.
Assuntos
Acidose/fisiopatologia , Encefalopatias Metabólicas/fisiopatologia , Encefalite/fisiopatologia , Febre/fisiopatologia , Vírus da Influenza A Subtipo H1N1/imunologia , Influenza Humana/fisiopatologia , Choque Hemorrágico/fisiopatologia , Acidose/complicações , Acidose/imunologia , Acidose/virologia , Encefalopatias Metabólicas/complicações , Encefalopatias Metabólicas/imunologia , Encefalopatias Metabólicas/virologia , Pré-Escolar , Citocinas/análise , Citocinas/imunologia , Encefalite/complicações , Encefalite/imunologia , Encefalite/virologia , Evolução Fatal , Febre/complicações , Febre/imunologia , Febre/virologia , Hong Kong , Hospitalização , Humanos , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/complicações , Influenza Humana/imunologia , Influenza Humana/virologia , Masculino , Choque Hemorrágico/complicações , Choque Hemorrágico/imunologia , Choque Hemorrágico/virologia , SíndromeRESUMO
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.
Assuntos
Gânglios da Base/fisiopatologia , Encefalopatias Metabólicas/fisiopatologia , Coagulação Intravascular Disseminada/fisiopatologia , Encefalite Viral/fisiopatologia , Síndromes Neurotóxicas/fisiopatologia , Infecções por Roseolovirus/fisiopatologia , Gânglios da Base/enzimologia , Gânglios da Base/imunologia , Gânglios da Base/virologia , Biomarcadores/sangue , Encefalopatias Metabólicas/sangue , Encefalopatias Metabólicas/complicações , Encefalopatias Metabólicas/imunologia , Encefalopatias Metabólicas/virologia , Carnitina O-Palmitoiltransferase/sangue , Pré-Escolar , Citocinas/sangue , Citocinas/imunologia , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/complicações , Coagulação Intravascular Disseminada/imunologia , Coagulação Intravascular Disseminada/virologia , Eletroencefalografia , Encefalite Viral/sangue , Encefalite Viral/complicações , Encefalite Viral/imunologia , Encefalite Viral/virologia , Feminino , Herpesvirus Humano 6 , Humanos , Lactente , Japão , Imageamento por Ressonância Magnética , Síndromes Neurotóxicas/sangue , Síndromes Neurotóxicas/complicações , Síndromes Neurotóxicas/imunologia , Síndromes Neurotóxicas/virologia , Reação em Cadeia da Polimerase , Infecções por Roseolovirus/sangue , Infecções por Roseolovirus/complicações , Infecções por Roseolovirus/imunologia , Infecções por Roseolovirus/virologia , Equilíbrio Th1-Th2RESUMO
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.
Assuntos
Infecções por Adenoviridae/complicações , Encefalopatias Metabólicas/patologia , Corpo Caloso/patologia , Encefalite/patologia , Irmãos , Povo Asiático , Encéfalo/patologia , Encéfalo/fisiopatologia , Encefalopatias Metabólicas/genética , Encefalopatias Metabólicas/virologia , Edema Encefálico/metabolismo , Edema Encefálico/fisiopatologia , Criança , Pré-Escolar , Corpo Caloso/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Encefalite/genética , Encefalite/virologia , Feminino , Predisposição Genética para Doença/genética , Humanos , Padrões de Herança/genética , Japão , Fibras Nervosas Mielinizadas/metabolismo , Fibras Nervosas Mielinizadas/patologia , Síndrome , Equilíbrio HidroeletrolíticoRESUMO
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.
Assuntos
Encéfalo/metabolismo , Encéfalo/fisiopatologia , Encefalite Viral/metabolismo , Encefalite Viral/fisiopatologia , Hepatite C/complicações , Astrócitos/virologia , Encéfalo/virologia , Encefalopatias Metabólicas/metabolismo , Encefalopatias Metabólicas/fisiopatologia , Encefalopatias Metabólicas/virologia , Quimiotaxia de Leucócito/fisiologia , Encefalite Viral/virologia , Hepacivirus/fisiologia , Humanos , Leucócitos Mononucleares/virologia , Microglia/virologiaRESUMO
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.
Assuntos
Encefalopatias Metabólicas/virologia , Coreia/virologia , Infecções por Parvoviridae/complicações , Parvovirus B19 Humano/isolamento & purificação , Encefalopatias Metabólicas/imunologia , Criança , Coreia/imunologia , Progressão da Doença , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Infecções por Parvoviridae/diagnóstico , Infecções por Parvoviridae/imunologia , Reação em Cadeia da Polimerase , Fatores de TempoRESUMO
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.
Assuntos
Encefalopatias Metabólicas/virologia , Sistema Nervoso Central/fisiopatologia , Dengue/complicações , Encefalite Viral/fisiopatologia , Encefalite Viral/virologia , Adolescente , Adulto , Idoso , Encefalopatias Metabólicas/diagnóstico , Encefalopatias Metabólicas/fisiopatologia , Sistema Nervoso Central/patologia , Sistema Nervoso Central/virologia , Criança , Pré-Escolar , Creatina Quinase/sangue , Eletroencefalografia , Encefalite Viral/diagnóstico , Feminino , Globo Pálido/patologia , Globo Pálido/fisiopatologia , Globo Pálido/virologia , Humanos , Leucocitose/diagnóstico , Leucocitose/fisiopatologia , Leucocitose/virologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Debilidade Muscular/virologia , Mioclonia/diagnóstico , Mioclonia/fisiopatologia , Mioclonia/virologia , Miosite/complicações , Miosite/fisiopatologia , Miosite/virologia , Estudos Prospectivos , Convulsões/diagnóstico , Convulsões/fisiopatologia , Convulsões/virologia , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Medula Espinal/virologiaRESUMO
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.