1/19. Subacute measles encephalitis in a young man immunosuppressed for ankylosing spondylitis.Subacute measles encephalitis occurred 1 month after measles onset in a 26-year-old hiv-negative man undergoing immunosuppressive treatment for ankylosing spondylitis. He had seizures, a decline in mental status, and progressive impairment of consciousness, with a fatal outcome. Despite severely deficient cellular immunity, the elevated antimeasles antibody titers and CSF findings indicated that humoral immunity was not impaired. Histologic, electron microscopic, and immunocytochemical studies revealed the typical intranuclear inclusions of paramyxovirus nucleocapsids, and measles virus antigen in neurons and oligodendrocytes.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
2/19. Sequential MRI, SPECT and PET in respiratory syncytial virus encephalitis.We report on a 3-year-old girl with respiratory syncytial virus (RSV) encephalitis manifested by disturbance of consciousness, conjugate eye deviation, anuria, truncal ataxia and intention tremor. T2-weighted magnetic resonance imaging (MRI) showed hyperintense areas in the cerebellar cortex. No lesion was detected in the cerebral cortex, pons or spinal cord. The hyperintense areas in the cerebellar cortex diminished with recovery from the clinical manifestations and had resolved 2 months after onset. The MRI lesions in the cerebellum were considered to be due to oedema. SPECT and positron emission tomography (PET), performed 3 months after onset, disclosed areas of hypoperfusion and hypometabolism at the same sites. One year after onset, MRI showed mild atrophy of the cerebellum. Hypoperfusion on SPECT and hypometabolism on PET remained. neuroimaging showed that ataxia and tremor in this case were the result of cerebellitis. The patient has no neurological deficit except for mild truncal ataxia. This patient is a rare example of RSV encephalitis.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
3/19. Outbreak of Nipah-virus infection among abattoir workers in singapore.BACKGROUND: In March 1999, an outbreak of encephalitis and pneumonia occurred in workers at an abattoir in singapore. We describe the clinical presentation and the results of investigations in these patients. methods: Clinical and laboratory data were collected by systemic review of the case records. serum and cerebrospinal fluid (CSF) samples were tested for IgM antibodies to nipah virus with an IgM capture ELISA. Reverse-transcriptase PCR was done on the CSF and tissue samples from one patient who died. FINDINGS: Eleven patients were confirmed to have acute Nipah-virus infection based on raised IgM in serum. nipah virus was identified by reverse transcriptase PCR in the CSF and tissue of the patient who died. The patients were all men, with a median age of 44 years. The commonest presenting symptoms were fever, headache, and drowsiness. Eight patients presented with signs of encephalitis (decreased level of consciousness or focal neurological signs). Three patients presented with atypical pneumonia, but one later developed hallucinations and had evidence of encephalitis on CSF examination. Abnormal laboratory findings included a low lymphocyte count (nine patients), low platelet count, low serum sodium, and high aspartate aminostransferase concentration (each observed in five patients). The CSF protein was high in eight patients and white-blood-cell count was high in seven. Chest radiography showed mild interstitial shadowing in eight patients. magnetic resonance imaging (MRI) showed focal areas of increased signal intensity in the cortical white marker in all eight patients who were scanned. The nine patients with encephalitis received empirical treatment with intravenous aciclovir and eight survived. INTERPRETATION: infection with nipah virus caused an encephalitis illness with characteristic focal areas of increased intensity seen on MRI. lung involvement was also common, and the disease may present as an atypical pneumonia.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
4/19. Fatal encephalitis due to nipah virus among pig-farmers in malaysia.BACKGROUND: Between February and April, 1999, an outbreak of viral encephalitis occurred among pig-farmers in malaysia. We report findings for the first three patients who died. methods: Samples of tissue were taken at necropsy. Blood and cerebrospinal-fluid (CSF) samples taken before death were cultured for viruses, and tested for antibodies to viruses. FINDINGS: The three pig-farmers presented with fever, headache, and altered level of consciousness. myoclonus was present in two patients. There were signs of brainstem dysfunction with hypertension and tachycardia. Rapid deterioration led to irreversible hypotension and death. A virus causing syncytial formation of vero cells was cultured from the CSF of two patients after 5 days; the virus stained positively with antibodies against hendra virus by indirect immunofluorescence. IgM capture ELISA showed that all three patients had IgM antibodies in CSF against Hendra viral antigens. Necropsy showed widespread microinfarction in the central nervous system and other organs resulting from vasculitis-induced thrombosis. There was no clinical evidence of pulmonary involvement. inclusion bodies likely to be of viral origin were noted in neurons near vasculitic blood vessels. INTERPRETATION: The causative agent was a previously undescribed paramyxovirus related to the hendra virus. Close contact with infected pigs may be the source of the viral transmission. Clinically and epidemiologically the infection is distinct from infection by the hendra virus. We propose that this Hendra-like virus was the cause of the outbreak of encephalitis in malaysia.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
5/19. Reversible frontal lobe syndrome associated with influenza virus infection in children.Two patients, a 3-year-old female and a 1-year-old female, both with a focal encephalopathic process associated with influenza a virus infection, are reported. Both children had neuropsychologic signs suggesting frontal and limbic dysfunction, without disturbances of consciousness or motor function, and had good recoveries. The results of single-photon emission computed tomography and electroencephalography support the finding of reversible impairment of the frontal and limbic areas. Focal reversible encephalopathy has rarely been reported in association with influenza virus infection, although it often provokes diffuse encephalopathies, with a poor prognosis.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
6/19. Infantile bilateral striatal necrosis following measles.A previously healthy 4-year-old boy presented with typical measles and demonstrated lesions confined to basal ganglia. The clinical symptoms were an abrupt onset, impaired consciousness and mutism, extrapyramidal signs and severe neurovegetative dysfunction. No modification of the cerebrospinal fluid was observed; laboratory tests were all normal with the exception of a positive serologic test for measles. Cranial magnetic resonance imaging showed abnormal signals in the striatum, affecting the putamen and the caudate nuclei bilaterally. Neurologic improvement occurred within 2 months, with regression of lesions on cranial imaging, suggesting that edema played an important role in the initial stage of the disease.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
7/19. Enteroviral encephalitis leading to a locked-in state.Millions of children are infected by enteroviruses each year, usually exhibiting only mild symptoms. Although enteroviruses are a common cause of community-acquired aseptic meningitis, enteroviral meningitis usually has a benign course. We describe a 14-year-old patient with enteroviral meningoencephalitis diagnosed by polymerase chain reaction. Her level of consciousness declined rapidly after hospital admission and resulted in a locked-in state. Although she experienced slow neurologic improvement, residual neurologic deficits remain. Although there is a general awareness of the characteristics of enteroviralencephalitis, this case report is significant in presenting a case of unusual severity and sequelae. To our knowledge, this is the first published report of an enterovirus encephalitis leading to a locked-in-state.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
8/19. Nipah encephalitis outbreak in malaysia, clinical features in patients from Seremban.BACKGROUND: An outbreak of viral encephalitis occurred among pig industry workers in malaysia in September 1998 to April 1999. The encephalitis was attributed to a new paramyxovirus, nipah virus. This is a description of the clinical features of 103 patients treated in the Seremban Hospital with characterization of the prognostic factors. methods: Clinical case records and laboratory investigations were reviewed. The case definition was: patients from the outbreak area, direct contact or in close proximity with pigs, clinical or CSF features of encephalitis. RESULTS: The mean age was 38 years, 89% were male, 58% were ethnic Chinese, 78% were pig farm owners or hired workers. The mean incubation period was 10 days. The patients typically presented with nonspecific systemic symptoms of fever, headache, myalgia and sore throat. seizures and focal neurological signs were seen in 16% and 5% respectively. In the more severe cases, this was followed by drowsiness and deteriorating consciousness requiring ventilation in 61%. Autonomic disturbances and myoclonic jerks were common features. The mortality was high at 41%. Systolic hypertension, tachycardia and high fever were associated with poor outcome. On the other hand, 40% recovered fully. As for the other 19%, the residual neurological signs were mostly mild. CONCLUSION: nipah virus caused an encephalitis illness with short incubation period and high mortality. The prognosis for the survivors was good.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
9/19. Encephalitis and myocarditis in a child with acute lymphoblastic leukemia: role of coxsackievirus B5?Enteroviruses are common causes of viral encephalitis in childhood and the most common cause of myocarditis. The prognosis is good with exception of the immunocompromised children who are at higher risk with increased mortality. A case of a 7-year-old boy with acute lymphoblastic leukemia and coxsackievirus B5-associated encephalitis and myocarditis is described. The boy was in complete remission and coxsackievirus B5 infection occurred 22 months after the beginning of chemotherapy. The clinical manifestations were fever, seizures, and altered consciousness. He underwent only supportive treatment. He had an excellent outcome; 2 years later he is still in complete remission with normal electroencephalogram and normal cardiac function.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
10/19. Human herpesvirus-6 encephalitis after unrelated umbilical cord blood transplant in children.Three children developed human herpesvirus-6 (HHV-6), variant B encephalitis after unrelated umbilical cord blood transplant, in a single center. They developed clinical manifestations of encephalitis around day 17 post transplant. Impairment of consciousness, incoherent speech, episodic focal pruritis, motor weakness, convulsions and severe hyponatremia were features at presentation. Radiological investigation of brain ranged from unremarkable to extensive white matter and meningeal lesions. Diagnosis was established by the presence of HHV-6 dna in cerebrospinal fluid (CSF). Retrospective analyses of plasma revealed the presence of viral DNAemia prior to the onset of disease in two subjects. Treatment with ganciclovir or foscarnet was given. Two subjects did not achieve engraftment and died of other transplant-related complications on day 38 and 56 post-transplant, respectively. One subject achieved disease-free survival for more than 1 year with a satisfactory neurological outcome. In conclusion, HHV-6 encephalitis is not uncommon among patients undergoing umbilical cord blood transplantation. It is worth conducting further studies on early diagnosis and optimal management of this potentially fatal disease.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
| | Next -> |