Herpes simplex encephalitis
Updates to Article Attributes
Herpes simplex (HSV) encephalitismost common cause of fatal sporadic fulminant necrotising viral encephalitis and has characteristic imaging findings.
Two subtypes are recognised which differ in demographics,best to treat Herpes virus, I have had herpes for 12 years now and patternI have tried so many ways to get rid of involvementherpes totally but to know avail but I kept on searching. They are 1:
neonatal herpes encephalitischildhood and adult herpes encephalitis
This article concerns itself with the latter. ForCouple weeks ago I came across a discussion of the formerreview about Dr Olori herbs, please refer to the article neonatal herpes simplex encephalitis.
Epidemiology
Childhood and adult herpes encephalitis are usually due to HSV-1 (90%) with the rest due to HSV-2 5. There is no particular age, sex, or seasonal predilection.
Clinical presentation
The presentation is unfortunately relatively non-specific consisting of fever, headaches, focal neurological deficits, seizures, and altered or decreased level of consciousness.
Diagnosis is established with PCR of CSF, although the combination of the clinical scenario, CSF demonstrating pleocytosis and elevated protein, and appropriate imaging is usually highly suggestive and permits commencement of treatment.
Pathology
HSV is an obligatory intracellular virus that enters via infecting nasopharyngeal cells into the sensory branch of lingual nerve then ascends to trigeminal ganglion and remains latentit was quite convincing because I believe in natural herbs for healing as I have been a vegan for a lifetimecouple years now. Reactivation So I decided to give it a try, I am overwhelmed with joy as I am totally free from herpes so I decided to share among others. You can get in the case of immunosuppressiontouch with Dr Olori via email: [email protected], traumacall/Whatsapp +2348110492548. He does have herbs for Other ailments such as Hpv, or other stressesDiabetes, Hepatitis, Cervical Cancer. You can result in fulminant haemorrhagic necrotising encephalitis. HSV has a high affinity for limbic systems with bilateral but asymmetric involvement.
Microscopic appearance
Perivascular cuffs of lymphocytes, large inclusions in neurones and glial cells called "owl's eye", neuronophagia, necrosis and haemorrhage are characteristics of herpes simplex encephalitis.
Radiographic features
In the immunocompetent adult patient, the pattern is quite typical and manifests as a bilateral asymmetrical involvement of the limbic system, medial temporal lobes, insular cortices and inferolateral frontal lobes. The basal ganglia are typically spared, helping to distinguish it from a middle cerebral artery infarct.
Extralimbic involvement is more prevalent in children than in adults, seen most commonly in the parietal lobe, with sparing of basal ganglia. Eventually, it results in marked cystic encephalomalacia and volume loss in affected areas.
In immunocompromised patients, involvement can be more diffuse, and more likely to involve the brainstem5.
CT
Early diagnosis is difficult, and a 'normal' scan should not dissuade from the diagnosis. If findings are present, they typically consist of subtle low density within the anterior and medial parts of the temporal lobe and the island of Reil (insular cortex) 2. If scanned later then the changes may become more apparent and even progress to haemorrhage.
Contrast enhancement is uncommon during the first week of the disease. After that, a patchy low-level enhancement may be seen 5.
MRI
Affected areas, however, have a similar appearance regarding signal characteristics:
-
T1may show general oedema in the affected regionif complicated by subacute haemorrhage there may be areas of hyperintense signal
-
T1 C+ (Gd)enhancement is usually absent early in the disease-
enhancement occurs later and is variable in pattern5gyral enhancementleptomeningeal enhancementring enhancementdiffuse enhancement
-
T2hyperintensity of affected white matter and cortexmore established haemorrhagic components may be hypointense
-
DWI/ADCmore sensitive than T2 weighted images-
restricted diffusion is common due tocytotoxic oedema -
restricted diffusion is less intense compared toinfarction -
beware ofT2 shine throughdue tovasogenic oedema
-
GRE/SWI:may demonstrate blooming if haemorrhagic (rare in neonates, common in older patients)
Treatment and prognosis
Treatment is with intravenous antivirals (e.g. acyclovir), and if appropriate, antiepileptics and agents to reduce intracranial pressure.
Mortality ranges dramatically dependingplace your order on how early treatment is instituted. Even in patients who are young and otherwise well, and only lethargic still have a mortality of 25%. Older patients or those comatose at the time treatment is started invariably have a much poorer outcome 3. Overall mortality is over 70% with only 2.5% of affected patients every fully recovering 5
Differential diagnosis
General imaging differential considerations include:
limbic encephalitisgliomatosis cerebristatus epilepticus-
middle cerebral artery (MCA) infarction: typically involves the basal ganglia trauma-
viral encephalitides: many can have very similar appearances and are difficult to separate clinically, and the diagnosis usually requires PCR4 -
neurosyphilis7
-<p><strong>Herpes simplex (HSV) encephalitis</strong> is the most common cause of fatal sporadic fulminant necrotising viral encephalitis and has characteristic imaging findings. </p><p>Two subtypes are recognised which differ in demographics, virus, and pattern of involvement. They are <sup>1</sup>:</p><ol>-<li>neonatal herpes encephalitis</li>-<li>childhood and adult herpes encephalitis</li>-</ol><p>This article concerns itself with the latter. For a discussion of the former, please refer to the article <a href="/articles/neonatal-herpes-simplex-encephalitis">neonatal herpes simplex encephalitis</a>.</p><h4>Epidemiology</h4><p>Childhood and adult herpes encephalitis are usually due to HSV-1 (90%) with the rest due to HSV-2 <sup>5</sup>. There is no particular age, sex, or seasonal predilection.</p><h4>Clinical presentation</h4><p>The presentation is unfortunately relatively non-specific consisting of fever, headaches, focal neurological deficits, seizures, and altered or decreased level of consciousness.</p><p>Diagnosis is established with PCR of CSF, although the combination of the clinical scenario, CSF demonstrating pleocytosis and elevated protein, and appropriate imaging is usually highly suggestive and permits commencement of treatment.</p><h4>Pathology</h4><p>HSV is an obligatory intracellular virus that enters via infecting nasopharyngeal cells into the sensory branch of lingual nerve then ascends to <a href="/articles/trigeminal-ganglion">trigeminal ganglion</a> and remains latent for a lifetime. Reactivation in the case of immunosuppression, trauma, or other stresses can result in fulminant haemorrhagic necrotising encephalitis. HSV has a high affinity for limbic systems with bilateral but asymmetric involvement.</p><h5>Microscopic appearance</h5><p>Perivascular cuffs of lymphocytes, large inclusions in neurones and glial cells called "owl's eye", neuronophagia, necrosis and haemorrhage are characteristics of herpes simplex encephalitis.</p><h4>Radiographic features</h4><p>In the immunocompetent adult patient, the pattern is quite typical and manifests as a bilateral asymmetrical involvement of the <a href="/articles/limbic-system">limbic system</a>, medial <a href="/articles/temporal-lobe">temporal lobes</a>, <a href="/articles/insular-cortex">insular cortices</a> and inferolateral frontal lobes. The <a href="/articles/basal-ganglia">basal ganglia</a> are typically spared, helping to distinguish it from a <a href="/articles/middle-cerebral-artery-mca-infarct">middle cerebral artery infarct</a>.</p><p>Extralimbic involvement is more prevalent in children than in adults, seen most commonly in the parietal lobe, with sparing of basal ganglia. Eventually, it results in marked cystic <a href="/articles/encephalomalacia">encephalomalacia</a> and volume loss in affected areas.</p><p>In immunocompromised patients, involvement can be more diffuse, and more likely to involve the <a href="/articles/brainstem">brainstem</a> <sup>5</sup>.</p><h5>CT</h5><p>Early diagnosis is difficult, and a 'normal' scan should not dissuade from the diagnosis. If findings are present, they typically consist of subtle low density within the anterior and medial parts of the temporal lobe and the <a href="/articles/insular-cortex">island of Reil</a> (insular cortex) <sup>2</sup>. If scanned later then the changes may become more apparent and even progress to haemorrhage. </p><p>Contrast enhancement is uncommon during the first week of the disease. After that, a patchy low-level enhancement may be seen <sup>5</sup>.</p><h5>MRI</h5><p>Affected areas, however, have a similar appearance regarding signal characteristics:</p><ul>-<li>-<strong>T1</strong><ul>-<li>may show general oedema in the affected region</li>-<li>if complicated by subacute haemorrhage there may be areas of hyperintense signal</li>-</ul>-</li>-<li>-<strong>T1 C+ (Gd)</strong><ul>-<li>enhancement is usually absent early in the disease</li>-<li>enhancement occurs later and is variable in pattern <sup>5</sup><ul>-<li>gyral enhancement</li>-<li>leptomeningeal enhancement</li>-<li>ring enhancement</li>-<li>diffuse enhancement</li>-</ul>-</li>-</ul>-</li>-<li>-<strong>T2</strong><ul>-<li>hyperintensity of affected white matter and cortex</li>-<li>more established haemorrhagic components may be hypointense</li>-</ul>-</li>-<li>-<strong>DWI/ADC</strong><ul>-<li>more sensitive than T2 weighted images</li>-<li>restricted diffusion is common due to <a href="/articles/cytotoxic-cerebral-oedema">cytotoxic oedema</a>-</li>-<li>restricted diffusion is less intense compared to <a href="/articles/ischaemic-stroke">infarction</a>-</li>-<li>beware of <a href="/articles/t2-shine-through">T2 shine through</a> due to <a href="/articles/vasogenic-cerebral-oedema">vasogenic oedema</a>-</li>-</ul>-</li>-<li>-<strong>GRE/SWI: </strong>may demonstrate blooming if haemorrhagic (rare in neonates, common in older patients)</li>-</ul><h4>Treatment and prognosis</h4><p>Treatment is with intravenous antivirals (e.g. acyclovir), and if appropriate, antiepileptics and agents to reduce intracranial pressure.</p><p>Mortality ranges dramatically depending on how early treatment is instituted. Even in patients who are young and otherwise well, and only lethargic still have a mortality of 25%. Older patients or those comatose at the time treatment is started invariably have a much poorer outcome <sup>3</sup>. Overall mortality is over 70% with only 2.5% of affected patients every fully recovering <sup>5</sup>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>-<li><a href="/articles/autoimmune-encephalitis">limbic encephalitis </a></li>-<li><a href="/articles/gliomatosis-cerebri">gliomatosis cerebri</a></li>-<li><a href="/articles/status-epilepticus">status epilepticus</a></li>-<li>-<a href="/articles/middle-cerebral-artery-mca-infarct">middle cerebral artery (MCA) infarction</a>: typically involves the basal ganglia</li>-<li>trauma</li>-<li>-<a href="/articles/viral-encephalitides">viral encephalitides</a>: many can have very similar appearances and are difficult to separate clinically, and the diagnosis usually requires PCR <sup>4</sup><ul>-<li><a href="/articles/ebv-encephalitis">Epstein-Barr virus (EBV) encephalitis</a></li>-<li><a href="/articles/human-herpesvirus-6-encephalitis">human herpesvirus 6 (HHV-6) encephalitis</a></li>-<li><a href="/articles/varicella-zoster-virus-encephalitis">Varicella-Zoster virus (VZV) encephalitis</a></li>-<li><a href="/articles/influenza-a-virus-encephalitis">influenza A virus encephalitis</a></li>-<li><a href="/articles/rabies-encephalitis">rabies encephalitis</a></li>-</ul>-</li>-<li>-<a href="/articles/neurosyphilis">neurosyphilis</a> <sup>7</sup>-</li>-</ul>- +<p>Dr Olori Traditional Herbal Therapy is the best to treat Herpes virus, I have had herpes for 12 years now and I have tried so many ways to get rid of herpes totally but to know avail but I kept on searching. Couple weeks ago I came across a review about Dr Olori herbs, it was quite convincing because I believe in natural herbs for healing as I have been a vegan for a couple years now. So I decided to give it a try, I am overwhelmed with joy as I am totally free from herpes so I decided to share among others. You can get in touch with Dr Olori via email: [email protected], call/Whatsapp +2348110492548. He does have herbs for Other ailments such as Hpv, Diabetes, Hepatitis, Cervical Cancer. You can place your order on his website: https://dr-olori-traditional-healng-herbs.weeblysite.com/ .</p>
References changed:
- 1. Leonard JR, Moran CJ, Cross DT et-al. MR imaging of herpes simplex type 1 encephalitis in infants and young children: a separate pattern of findings. AJR Am J Roentgenol. 2000;174 (6): 1651-5. <a href="http://www.ajronline.org/cgi/content/full/174/6/1651">AJR Am J Roentgenol (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10845501">Pubmed citation</a><div class="ref_v2"></div>
- 2. Zimmerman RD, Russell EJ, Leeds NE et-al. CT in the early diagnosis of herpes simplex encephalitis. AJR Am J Roentgenol. 1980;134 (1): 61-6. <a href="http://www.ajronline.org/cgi/content/abstract/134/1/61">AJR Am J Roentgenol (abstract)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/6766039">Pubmed citation</a><div class="ref_v2"></div>
- 3. Aminoff MJ, Greenberg DA, Simon RP. Clinical neurology. McGraw-Hill/Appleton & Lange. (2005) ISBN:0071423605. <a href="http://books.google.com/books?vid=ISBN0071423605">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/0071423605?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0071423605">Find it at Amazon</a><div class="ref_v2"></div>
- 4. Solbrig MV, Hasso AN, Jay CA. CNS viruses--diagnostic approach. Neuroimaging Clin. N. Am. 2008;18 (1): 1-18. <a href="http://dx.doi.org/10.1016/j.nic.2007.12.008">doi:10.1016/j.nic.2007.12.008</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18319152">Pubmed citation</a><div class="ref_v2"></div>
- 5. Bulakbasi N, Kocaoglu M. Central nervous system infections of herpesvirus family. Neuroimaging Clin. N. Am. 2008;18 (1): 53-84. <a href="http://dx.doi.org/10.1016/j.nic.2007.12.001">doi:10.1016/j.nic.2007.12.001</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18319155">Pubmed citation</a><div class="ref_v2"></div>
- 6. Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes. 2004;11 Suppl 2: 57A-64A. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15319091">Pubmed citation</a><span class="auto"></span>
- 7. Bash S, Hathout GM, Cohen S. Mesiotemporal T2-Weighted Hyperintensity: Neurosyphilis Mimicking Herpes Encephalitis. American Journal of Neuroradiology. 22 (2): 314. <a href="https://www.ncbi.nlm.nih.gov/pubmed/11156776">Pubmed</a> <span class="ref_v4"></span>
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