A study on viral CNS inflammation beyond herpes encephalitis

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• 作者：Berit Jordan ; Sabrina Kösling ; Alexander Emmer ; Antje Koch…
• 关键词：Viral encephalitis ; Herpes simplex virus ; Varizella zoster virus ; CSF ; Diffusion ; weighted MRI
• 刊名：Journal of NeuroVirology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：22
• 期：6
• 页码：763-773
• 全文大小：
• 刊物主题：Neurosciences; Virology; Infectious Diseases; Immunology; Neurology;
• 出版者：Springer International Publishing
• ISSN：1538-2443
• 卷排序：22

文摘

The early diagnosis of herpes simplex virus encephalitis (HSVE) enables induction of antiviral therapy in this potentially life-threatening disease. The study aimed to determine clinical findings including cerebrospinal fluid (CSF) data and MRI imaging in HSVE patients and to identify features distinguishing HSVE from encephalitis of other viral etiologies. We retrospectively reviewed consecutive patients who were diagnosed with viral encephalitis between 2000 and 2014 at the University Hospital Halle. Forty-nine patients with viral encephalitis were identified. A viral etiology could be confirmed by PCR or antibody testing in 22/49 (44.9 %) of patients (15 (30.6 %) HSV, 5 (10.2 %) VZV, 2 (4.1 %) EBV). In HSVE, typical findings were focal slowing in electroencephalophy (EEG) (80 %, p = 0.021) and presence of cortical (86.7 %, p = 0.030) lesions in MRI. Restricted diffusion was particularly helpful in detection of early signal abnormalities in HSVE (p = 0.014). In 27/49 (55.1 %) of patients, no causative agent could be elucidated. In these patients, 15/27 (55.6 %) experienced a rather “benign” disease course with no MRI pathology despite initially HSVE mimicking clinical picture. However, CSF was significantly different showing a higher amount of granulocytes and activated lymphocytes. The remaining 12/27 (44.4 %) patients developed MRI changes consistent with encephalitis, in 4 of these patients, disease course was fatal. Beside PCR-based serology as standard procedure, MRI including diffusion-weighted images and EEG represent additional tools in early HSVE diagnosis. CSF cytology might be particularly supportive in differentiating likely benign forms of encephalitis.