Detection of herpes simplex virus and herpes simplex virus-antibodies in encephalitis and similar infectious diseases

The purpose of this study was to use the polymerase chain reaction [PCR] technique to detect herpes simplex virus genome in cerebrospinal fluid [CSF], together with enzyme immunoassay and antigen immunoblotting [AIB] to detect antibodies against herpes simplex virus, in 41 patients with encephalitis and similar infectious diseases of the central nervous system. None of the patients had the diagnosis of herpes simplex encephalitis. Cerebrospinal fluid and matched serum specimens were obtained within the first week of clinical symptoms. Oligoclonal IgG bands were found by isoelectric focusing in the cerebrospinal fluid of 20/41 patients of whom 9 had local synthesis and 11 had a systemic immune response. Antibody specific to herpes simplex virus was found by enzyme-linked immunosorbent assay [ELISA] in 10/33 patients tested. Herpes simplex virus-specific antibodies were found in the cerebrospinal fluid by antigen immunoblotting in 5/31 patients investigated, but these were of low affinity. There was no correlation between findings on ELISA and either the clinical diagnosis, the presence of oligoclonal IgG by isoelectric focusing, or the detection of specific antibodies by antigen immunoblotting. Careful interpretation of specific antibodies is necessary for they may result from non-specific activation by an unrelated agent. Polymerase chain reaction for herpes simplex virus deoxyribonucleic acid [DNA] may be used to help in the diagnosis of early cases of HSE and should also be considered in cases presenting with atypical clinical features and inconclusive results from laboratory tests

Mental deficiency and unstable bladder in a case of Marina's Syndrome

We report a case of Marfan's syndrome in a 23-year-old Arab man presenting with unstable bladder, and who was also found to have a mental deficiency. Familial occurrence of marfanoid habitus and heart abnormalities were detected. This is the first report of Marfan's syndrome in a patient from Kuwait and the Gulf region

Association of carotid artery disease and supratentorial tumor presenting with transient cerebral symptoms

A 70-year-old patient presented with transient cerebral symptoms. These were the only manifestations of coexistent carotid artery disease and a supratentorial tumor in a patient with otherwise normal neurological findings. Clinical presentation of both transient ischemic attacks and pseudovascular paroxysmal neurologic symptoms in this patient are discussed

Diagnosing Wilson's disease after craniocerebral injury

A15-year-old Palestinian patient was diagnosed with Wilson's disease that had been overlooked due to the occurrence of traumatic basal ganglia hemorrhage immediately before the first manifestations of the disease when the patient was 11 years of age. Only a few laboratory diagnostic tests were positive, and the diagnosis was finally confirmed by clinical improvement occurring 6 months after initiation of penicillamine treatment. This case points to the necessity of suspecting Wilson's disease in every young patient who presents with a change in behavior and difficulty in using his/her hands, even if a plausible explanation may exist