acyclovir and Aphasia

Topics: Acyclovir; Aphasia; Brain; Encephalitis, Viral; Fever; Herpes Simplex; Humans; Infant; Male; Seizures; Simplexvirus; Tomography, X-Ray Computed; Treatment Outcome; Vomiting

Topics: Acyclovir; Aphasia; Drug Administration Schedule; Encephalitis; Herpes Simplex; Humans; Immune Tolerance; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Recurrence

We identified an additional case of documented Rotavirus meningitis in an adult with full medical history. A previously healthy 37-year-old patient presented herself for transient aphasia associated with fever and headaches at the end of a one-week history of gastroenteritis. Cerebrospinal fluid (CSF) analysis revealed lymphocytic meningitis, and treatment with aciclovir was initiated. Rotavirus A reverse transcription-polymerase chain reaction (RT-PCR) was positive in CSF and the patient's stools in favor of Rotavirus meningitis. Testing for other viruses was negative. Magnetic resonance imaging (MRI) showed no signs of encephalitis. Aphasia was resolutive in less than 12 hours, and no neurological symptoms relapsed. All symptoms evolved favorably despite aciclovir discontinuation. Viral sequencing methods have recently identified unexpected viruses as potential causative agents in meningitis, including Rotavirus. We confirm the detectability of Rotavirus in the analysis of CSF in the context of Rotavirus gastroenteritis in an adult. This case suggests postviral headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome may be linked to previously undetected direct viral infection of the central nervous system. Therefore, clinicians should consider Rotavirus meningitis in diagnosing meningitis associated with gastroenteritis in adults.

Topics: Acyclovir; Adult; Aphasia; Gastroenteritis; Headache; Humans; Meningitis; Rotavirus

Topics: Acyclovir; Antiviral Agents; Aphasia; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Stroke

We report a rare case of relapsing herpes simplex encephalitis in a-37-year-old patient which was previously confirmed by positive polymerase chain reaction, herpes simplex virus (HSV) type1 IgG antibodies in cerebrospinal fluid and characterized on MRI. During the first admission, he was treated with continuous acyclovir treatment for one month with clinical improvement except for residual aphasia, for which he received a course of outpatient transcranial direct current stimulation (tDCS). A constant current of 1.2 mA was applied for 20 min twice daily. After the 4th day the patient was found to be irritable and uncooperative by staff and family members. A subsequent MRI showed significant deterioration of the lesion on comparison to the first MRI which led to discontinuation of tDCS.The relatively rapid exacerbation of HSV in only a few days is unusual. Our aim is to discuss if tDCS is related to HSV relapse and in doing so highlight possible mechanisms.

Topics: Acyclovir; Adult; Antiviral Agents; Aphasia; Brain; Electroencephalography; Encephalitis, Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Recurrence; Transcranial Direct Current Stimulation

Topics: Acyclovir; Antiviral Agents; Aphasia; Cerebrospinal Fluid; Colonic Neoplasms; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Fever; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Simplexvirus; Spinal Puncture; Temporal Lobe

Topics: Acyclovir; Aged; Amnesia; Aphasia; Blindness; Diagnosis, Differential; Humans; Male; Seizures; Treatment Outcome

Encephalitis presenting as a change in mental status can be challenging to recognize in the primary care setting. However, early detection via a low threshold of suspicion can be useful, leading in turn to early treatment and improved survival.. We present a case which we consider relevant to primary care practitioners. The patient in question presented with relatively mild mental status changes, progressing to confusion, dysnomia and delirium over a period of three days. While infection did not appear to be the leading cause on her differential diagnosis, she was found on extensive workup to have encephalitis caused by Herpes Simplex Virus type 1.. The case is instructive for general practitioners and other clinicians to maintain vigilance for central nervous system (CNS) infections which may present atypically.

Topics: Acyclovir; Antiviral Agents; Aphasia; Diagnosis, Differential; Disease Progression; Emergency Service, Hospital; Encephalitis, Herpes Simplex; Female; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction

Herpes zoster is uncommonly followed by cerebral infarction. The pathophysiological mechanism remains uncertain. Outcome is favorable after early specific treatment. We report the case of a 70-year-old woman who developed right hemiparesis with aphasia 15 days after thoracic herpes zoster. The herpes zoster induced cerebral vasculitis was hypothesized as no other etiology could be identified after detailed assessment of the cerebral infarction including brain MRI and cerebrospinal fluid study, and as the clinical course responded to antiviral therapy.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Aphasia; Brain Ischemia; Cerebral Angiography; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Paresis; Vasculitis, Central Nervous System; Vertebrobasilar Insufficiency

The syndrome of granulomatous angiitis related to varicella zoster virus infection often manifests as herpes zoster ophthalmicus followed by contralateral hemiplegia. Forty-five cases have been reported to date, and the authors' experience with two additional cases seen in a one-year period is described. Given the frequency of both stroke and herpes zoster ophthalmicus in an aging population, the authors postulate that granulomatous angiitis is underdiagnosed. There is need for increased awareness of this disease by the non-neurologist. Diagnostic and therapeutic considerations are reviewed.

Topics: Acyclovir; Adult; Aged; Angiography; Aphasia; Cerebrovascular Disorders; Diagnostic Errors; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Steroids; Syndrome; Vasculitis