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.

Management of acute viral encephalitis in Brazil

The appropriate management of acute viral encephalitis is a challenge. Clinical picture includes general symptoms and a wide range of neurological signs. Etiological diagnosis cannot be performed only by clinical means and depends on neuroimaging studies and cerebrospinal fluid molecular analyses. It is recommended since some of these viruses are treatable and that the prognoses of these infections depend on the prompt administration of antiviral and/or immunomodulatory drugs. The management of acute viral encephalitis in Brazil has some peculiarities. First, the etiological distribution of the viral encephalitis may differ from what is found in other countries. Some viruses, such as dengue virus, are more common in Brazil than in developed countries while others, like West Nile virus, are not found here. Second, there are some regions in Brazil where neuroimaging and laboratorial methods are not available, and a clinical-based decision is the only therapeutic approach. As most of the guidelines in the literature are based on complimentary methods, it is relevant to establish an alternative approach compatible with the Brazilian health system reality. The goal of this study was to review the recent advances in the field of the acute viral encephalitis, to discuss the diagnosis and the treatment of the main etiologies of acute viral encephalitis found in Brazil, and to propose a viable guideline for the evaluation of the suspected acute viral encephalitis cases in the emergence room in Brazil.

High doses of acyclovir: a new concept in the treatment of neonatal herpes simplex virus infection.

The authors present a case of a preterm newborn with congenital infection of herpes simplex virus type 2. The patient was treated with newly recommended high intravenous doses of acyclovir. It can be supposed that it reduces mortality, but the high morbidity continues to be a problem.

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

Diagnostic and therapeutic studies in herpes simplex encephalitis [HSE]

Twenty children [aged 1:4 years] with suspected HSE are studied. Main clinical presentations were fever, focal seizures altered state of consciousness and focal neurologic deficits. C.S.F. examination was normal in three cases and abnormal in 17 [85%]; with pleocytosis, increased protein concentration and excess R.B.Cs. Serologic studies revealed elevation of antiherpes antibodies in C.S.F. in 4 cases [20%] and in serum in 7 cases [35%]. CT. examination was normal in 15 patients, and abnormal in 5 cases [25%] showing reduced enhancement [hypodense area] in temporal lobe [s]. E.E.G. was abnormal in all patients, it revealed Periodic Lateralized Epileptiform Distharge [P.L.E.D] in 17 cases and other patterns denoting encephalopathy and periodic epileptiform activity in the rest. All patients received specific antiviral antiherpes drug [Acyclovir], in a 10 days course. Complete recovery occur in 12 cases, 6 patients survived with some residue and 2 patients dieded. Validity of newer tools of investigations is discussed

Encefalite por vírus herpes simples: consideraçöes diagnósticas e terapêuticas / Encephalitis by herpes simplex virus: diagnostic and therapeutic considerations

As meningoencefalites virais säo afecçöes relativamente comuns, sendo o vírus do herpes simplex o agente etiológico mais freqüente. O prognóstico das encefalites herpéticas alcançou melhora significativa a partir do advento do aciclovir. Os autores revisam, no presente artigo, os aspectos clínicos, diagnósticos e terapêuticos das encefalites virais, relatando o caso de uma paciente jovem, com boa evoluçäo clínica, a partir da instituiçäo precoce de terapêutica anti-viral.