Decompressive Craniectomy for Viral Encephalitis: Two Case Reports

A decompressive craniectomy is a therapeuticmodality not commonly used in cases of refractory intracranial hypertension due to viral encephalitis. In this article the authors present two cases of patients with viral encephalitis that have undergone decompressive craniectomy to control intracranial pressure. Both evolved with Glasgow outcome score of 4. The main clinical data for the surgical decision are Glasgow coma scale and the pupils of the patient associated with the imaging tests showing a large necrotic area and perilesional edema. The evolution of the patients undergoing decompression was satisfactory in 92.3% of cases.

Presentación del síndrome de Wernicke-Korsakoff secundario a encefalitis por citomegalovirus, a propósito de un caso / Wernicke-Korsakoff syndrome secondary to cytomegalovirus encephalitis: A case report

Resumen El citomegalovirus (CMV) es uno de los microorganismos oportunistas con mayor prevalencia en pacientes inmunocomprometidos, aunque su reactivación ha descendido después de la introducción de la terapia antirretroviral altamente activa (Highly Active Antiretroviral Therapy, HAART). En las coinfecciones, la encefalitis se ha reportado como una de las condiciones más frecuentes. Se presenta el caso de un paciente adulto joven con infección por virus de la inmunodeficiencia humana (HIV) que tuvo un rápido deterioro neurológico evidenciado en síntomas y signos clínicos clásicos del síndrome de Wernicke-Korsakoff y que no presentaba factores de riesgo para deficiencia de tiamina. En las imágenes de la resonancia magnética cerebral, se detectaron hallazgos típicos del síndrome, y se identificó citomegalovirus (CMV) en el líquido cefalorraquídeo. Con el tratamiento específico para el CMV, se logró el control de los síntomas, aunque hubo secuelas neurológicas que mejoraron. Este es uno de los pocos casos reportados a nivel mundial de síndrome de Wernicke secundario a encefalitis por citomegalovirus.

Abstract Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations. We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement. This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.

Encephalitis followed by optic neuritis: a case report and review of literature

Encephalitis has been included in the causes of optic neuritis, but post encephalitic optic neuritis has been rarely reported. Majority of the cases of optic neuritis are either idiopathic or associated with multiple sclerosis, especially in western countries. This is very important in the Asian population where the incidence and prevalence of multiple sclerosis is not as high as in the Western countries. Although post infectious optic neuritis is more common in children, it can also be found in adults and is usually seen one to three weeks after a symptomatic infective prodrome. Here, we present a case of a 48 year-old-male who developed optic neuritis following viral encephalitis. His first presentation was with severe headache of two weeks duration. Viral encephalitis was diagnosed and treated. The patient presented again three weeks later with right eye pain and other features typical of optic neuritis. Corticosteroid therapy facilitated prompt recovery. Optic neuritis is an uncommon manifestation of encephalitis. It is important that both doctors and patients remain aware of post infectious cause of optic neuritis, which would enable a timely diagnosis and treatment of this reversible cause of vision loss

A study of acute febrile encephalopathy with special reference to viral etiology.

OBJECTIVE: To study the etiological profile of patients with acute febrile encephalopathy syndrome focusing chiefly on the viral etiology, and to correlate clinical and radiological features of patients with viral encephalitis. METHODS: A prospective hospital based study conducted on the consecutive patients admitted in a pediatric unit during the period of 1(st) February 2004 to 31st January 2005 based on the following inclusion criteria: (1) Age more than 1 month and less than 18 years and (2) A diagnoses of acute febrile encephalopathy, based on the following criteria: (i) fever (ii) acute depression of consciousness or mental deterioration for more than 12 hours with or without motor or sensory deficit and (iii) Total duration of illness at the time of admission 1 week or less. RESULTS: The final study group comprised of 151 patients with mean age of 3.21 +/- 2.9 (range of mth-13 years) and male: female ratio of 1.71: 1. A diagnosis other than viral encephalitis was reached in 94 patients (62.3 %). Pyogenic meningitis was the most frequent diagnosis 51(33.8 %) followed by tubercular meningitis 12 (7.9 %), and cerebral malaria 8 (5.2 %) in the patient group of non-viral causes. Fifty-seven cases (37.3%) were suspected as viral encephalitis and mean age of the cases suspected as viral encephalitis was 2.8 +/- 2.9 (Range 1 mth-10 yrs) with male: female ratio of 1.28: 1. Etiological diagnosis was reached or considered probable in 41 (72%) cases out of the suspected patients. The most common etiological agent identified was enterovirus 71 in 20 patients (35.1 %). The other viruses identified were mumps in 6 (10.5%), Japanese encephalitis in 5 (8.7%), and measles in 4 (7%) cases. MRI brain was done in 39 patients and was abnormal in 14 patients. Out of 57 cases of suspected viral encephalitis 10 patients expired within 48 hours, 2 > 48 hours and 19 atients had significant neurological sequels at discharge. CONCLUSION: The etiology of acute febrile encephalopathy varies from infectious etiologies to noninfectious metabolic disorders. There are no distinguishing clinical or radiological features to differentiate the various causes of viral encephalitis. The clinical and the radiological findings in encephalitis should be interpreted in the geographical and other epidemiological background.

Hemorrhagic encephalopathy in dengue shock syndrome: a case report

Dengue fever is the most important arboviral infection in the world, with an estimated 100 million cases per year and 2.5 billion people at risk. Encephalopathy is a rare complication of dengue virus infection and may occur as a consequence of intracranial hemorrhage, cerebral edema, hyponatremia, cerebral anoxia, fulminant hepatic failure with portosystemic encephalopathy, microcapillary hemorrhage or release of toxic products. We report a rare case of hemorrhagic encephalopathy in dengue shock syndrome caused by type 3 dengue virus.

Persistant psychiatric symptoms after mumps encephalitis

Encephalitis refers to an inflammation of the brain tissues. It can involve different regions of the brain and can be caused by different etiological agents. In many cases it is followed by complete remission, but can also infrequently result in transient or persisting post encephalitis sequalae. These sequalae can manifest as a wide variety of clinical presentations, which pose challenges to clinicians in the realms of diagnosis and management. We report a case of persistent psychiatric symptoms following mumps encephalitis in an 8 years old child

Sindrome opercular en Pediatría: revisión del tema y presentación de tres casos clínicos / Opercular syndrome in paediatrics: clinical review and three case reports

The opercular syndrome is a rare neurological disease, affecting a small area of the telencephalic cortex overlying the insula known as operculum. Clinical signs are loss of voluntary control of orofacial muscles, with preservation of reflexes and automatic actions such as crying and laughing. Three cases of opercular syndrome are reported. The first is a boy with congenital bilateral parasylvian(?) syndrome; the second is a boy with opercular syndrome secondary to an acute viral encephalitis; and the third is a boy with psychomotor retardation whose diagnosis was established while being studied for convulsions. Aetiology, clinical aspects and imaginology of yhe syndrome - occasionally also affecting adults - are reviewed and discussed.

Case report: Dengue hemorrhagic fever with encephalopathy in an adult.

Encephalopathy in dengue hemorrhagic fever is a very rare condition and usually occurrs in the febrile stage. We report a 29-year-old woman, who presented with acute fever, thrombocytopenia and positive IgM antibodies for dengue virus. On the fourth hospital day, the fever subsided and she developed a confusional stage. CT scan and MRI of the brain were within normal limits. Electroencephalography (EEG) revealed generalized theta waves. Cerebrospinal fluid was normal. She was treated with supportive treatment. Five days later, she was fully recovered without any neurological deficits. This is a first case of encephalopathy in dengue hemorrhagic fever that developed after the fever subsided.

Multiple cranial nerve palsy in an HIV-positive patient.

We report the case of a 32 -year- old HIV-positive Indian male who presented with sixth nerve (bilateral), ninth, tenth and twelfth nerve palsies; cerebellar and posterior column involvement. CT scan showed gyriform enhancement in the right occipital lobe and nodular leptomeningeal enhancement in the left frontal lobe. Cytomegalovirus serology was positive and the patient was treated as presumed CMV. HIV can present with multiple cranial neuropathy and varied neurological involvement.

Post-encephalitic Kluver-Bucy syndrome.

Kluver-Bucy syndrome is a rare amalgamation of neurobehavioural signs and symptoms seen infrequently in humans following insult to bilateral temporal lobes. This report presents a case which along with emerging symptoms of Kluver-Bucy syndrome, developed Attention-Deficit/Hyperactivity Disorder (ADHD) consequent to viral encephalitis. The case highlights the presentation and management of this syndrome in a six-year-old girl with primary focus on the implications of Kluver-Bucy symptoms in current clinical practice involving neurobehavioural syndromes in children.

Encefalitis herpética a propósito de un caso clínico (importancia del diagnóstico y tratamiento precoz) / Herpesvirus encephalitis: report of a case (importance of diagnosis and early treatment)

La encefalitis por herpes virus simple tipo I es una enfermedad grave, que causa una elevada mortalidad y secuelas de importancia en quienes la sobreviven. En contraste, es de las pocas encefalitis que tiene un tratamiento específico (acyclovir) que ha mejorado sustancialmente el pronóstico vital y funcional de estos pacientes. La sospecha diagnóstica y el tratamiento precoz son fundamentales para revertir el cuadro clínico. La reacción en cadena de la polimerasa (PCR) en líquido cefalorraquídeo ha sustituido al estudio de biopsia cerebral en el diagnóstico positivo de la afección. Se presenta un caso clínico de encefalitis herpética, comentándose los pilares diagnósticos del proceso y su evolución característica. Se hace énfasis en la necesidad de tener en cuenta esta enfermedad ante todo cuadro neurológico febril de evolución aguda-subaguda y utilizar la terapéutica antiviral ante la sospecha de encefalitis herpética

Encefalitis Viral / Viral Encephalitis

Los virus se constituyen en una causa importante de encefalitis y meningoencefalitis en la edad pediátrica. Entre los implicados están el del sarampión, parotiditis, adenovirus, arbovirus, familia herpes virus, rabia, rubeola, entre otros. La encefalitis se ha definido como la inflamación del cerebro y las manifestaciones clínicas son diversas, siendo el resultado de la respuesta a este proceso inflamatorio, con hallazgos neurológicos específicos de acuerdo a las áreas del parénquima cerebral afectadas y que dependen del tipo de virus y de la respuesta inmune del individuo. El diagnóstico está basado en la historia clínica y el examen físico, complementado con estudios del líquido cefalorraquídeo, imagenología y cerología. El tratamiento es en general inespecífico, empírico y su objetivo es el de mantener la vida del paciente, prevenir y manejar las complicaciones. Se busca de este modo, llamar la atención sobre esta enfermedad, ya que el diagnóstico precoz y el tratamiento oportuno y adecuado, mejoran el pronóstico, disminuyen las secuelas y la mortalidad

Encefalitis herpética neonatal. Conceptos actuales a propósito de un caso / Current concepts and case report of neonatal herpetic encephalitis

El propósito de este reporte es presentar el caso de un recién nacido con infección por virus de herpes simple tipo 2 en sistema nervioso central. El diagnóstico se sospechó por las manifestaciones clínicas de la paciente y se confirmó por cultivo y detección de DNA de VHS en el líquido cefalorraquídeo. Se presentan conceptos actuales en cuanto a patogénesis, diagnóstico y tratamiento de esta infección viral en el período neonatal