acyclovir and Brain-Edema

Viral encephalitis causes an altered level of consciousness, which may be associated with fever, seizures, focal deficits, CSF pleocytosis, and abnormal neuroimaging. Potential pathogens include HSV, VZV, enterovirus, and in some regions, arboviruses. Autoimmune (eg, anti-NMDA receptor) and paraneoplastic encephalitis are responsible for some cases where no pathogen is identified. Indications for ICU admission include coma, status epilepticus and respiratory failure. Timely initiation of anti-viral therapy is crucial while relevant molecular and serological test results are being performed. Supportive care should be directed at the prevention and treatment of cerebral edema and other physiological derangements which may contribute to secondary neurological injury.

Topics: Acyclovir; Adrenal Cortex Hormones; Anticonvulsants; Antiviral Agents; Brain Diseases; Brain Edema; Consciousness Disorders; Encephalitis; Encephalitis, Viral; Encephalomyelitis, Acute Disseminated; Glasgow Coma Scale; Guillain-Barre Syndrome; Hashimoto Disease; Humans; Intensive Care Units; Paraneoplastic Syndromes, Nervous System; Seizures; Status Epilepticus; Viremia

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Brain Edema; Bromodeoxyuridine; Dexamethasone; Drug Therapy, Combination; Encephalitis; Ganciclovir; Herpes Simplex; Humans; Immunoglobulins; Interferons; Vidarabine

To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy.. The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting.. Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids.. This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Brain Edema; Encephalitis, Herpes Simplex; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroimaging; Simplexvirus; Temporal Lobe; Treatment Outcome

Herpes simplex virus (HSV) encephalitis affects 2-4 people per million/year. Immunocompomised patients can have atypical presentations of HSV encephalitis, including a lack of cerebrospinal fluid (CSF) pleocytosis. We present the case of a patient who was receiving ustekinumab therapy for psoriasis which inhibits interleukin (IL)-12 and IL-23 signalling pathways. The initial presentation was suggestive of encephalitis, but he was discharged prior to the reporting of HSV positivity due to the lack of CSF pleocytosis. On representation, he had worsening symptoms and imaging showed midline shift, indicating cerebral oedema despite the immunosupressant effects of ustekinumab. He required intensive care unit support and treatment with high dose aciclovir and dexamethasone; after a month of treatment he made a good recovery. This case is the first to report a link between ustekinumab and HSV encephalitis, and also emphasises that imunocompromised patients can lack CSF pleocytosis and develop significant cerebral oedema which responds to immune suppression.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Brain Edema; Dermatologic Agents; Dexamethasone; Diagnosis, Differential; Encephalitis, Herpes Simplex; Humans; Immunocompromised Host; Male; Psoriasis; Ustekinumab

Topics: Acyclovir; Adult; Anticonvulsants; Antiviral Agents; Brain; Brain Edema; Confusion; Diuretics, Osmotic; DNA, Viral; Encephalitis, Herpes Simplex; Fever; Herpesvirus 1, Human; Humans; Male; Mannitol; Polymerase Chain Reaction; Seizures; Temporal Lobe; Tomography, X-Ray Computed

In Western populations, especially in France, most severe influenza cases are observed in adults. Some cases are also recorded in children, especially influenza-associated encephalitis. This is contrary to what occurs in Japan where influenza-associated encephalitis is frequent and severe in children. We describe three cases of influenza-associated encephalitis in children who were hospitalized in the pediatric intensive care unit (PICU) during the winter of 2012-2013. The patients did not necessarily show the usual symptoms of influenza and were admitted to the PICU because of their severe neurological symptoms. Two children showed multiple-organ failure, as in the cases reported in Japan. The outcomes ranged from small residual signs to death. These cases remind us that the severe influenza complications that are common in Japan are also seen in France.

Topics: Acyclovir; Brain; Brain Death; Brain Edema; Child, Preschool; Combined Modality Therapy; Electroencephalography; Encephalitis, Viral; Fatal Outcome; Female; Follow-Up Studies; Humans; Hypoxia-Ischemia, Brain; Infant; Influenza A virus; Influenza B virus; Influenza, Human; Magnetic Resonance Imaging; Male; Neurologic Examination; Recurrence; Tomography, X-Ray Computed

We describe the case of a 19-year-old male diagnosed with Reye syndrome within the context of viral pericarditis and salicylate ingestion. He presented a fatal brain oedema without liver failure. Brain biopsies obtained during a decompressive craniectomy led to the diagnosis.

Topics: Acyclovir; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Aspirin; Brain Edema; Coma; Decompressive Craniectomy; Fatal Outcome; Glasgow Coma Scale; Humans; Magnetic Resonance Imaging; Male; Pericarditis; Resuscitation; Reye Syndrome; Seizures; Virus Diseases; Young Adult

Topics: Acyclovir; Adult; Brain Edema; Cerebral Hemorrhage; Craniotomy; Emergencies; Encephalitis, Herpes Simplex; Fatal Outcome; Female; Hematoma; Hemiplegia; Humans; Magnetic Resonance Imaging; Mydriasis; Respiratory Insufficiency; Temporal Lobe; Tomography, X-Ray Computed

Despite antiviral treatment and advances in critical care, the Herpes simplex encephalitis (HSE) still has a poor outcome in a significant portion of patients. In severe cases of HSE, reduced carbon dioxide reactivity is usually present and these patients don't respond to the usual treatment of brain edema and intracranial hypertension. We present case series of patients with severe form of HSE treated with therapeutic hypothermia (TH) and describe in detail the indications, methods, and the rationale for its use. In this case series, patients presented with severely impaired consciousness and very high predicted death rate as measured by Glasgow coma scale and Acute Physiology and Chronic Health Evaluation (APACHE II) score respectively. According to our findings, TH in carefully selected patients with HSE holds promise as an adjunctive to the antiviral treatment.

Topics: Acyclovir; Aged; Antiviral Agents; Brain Edema; Carbon Dioxide; Disease Progression; Encephalitis, Herpes Simplex; Encephalocele; Glasgow Coma Scale; Humans; Hypothermia, Induced; Infusions, Intravenous; Male; Middle Aged; Optic Nerve; Oximetry; Prognosis; Tomography, X-Ray Computed; Ultrasonography, Doppler, Transcranial

Topics: Acyclovir; Aged; Amphotericin B; Aneurysm; Aneurysm, Infected; Anti-Infective Agents; Brain Edema; Carotid Artery Diseases; Carotid Artery, Internal; Ceftriaxone; Dexamethasone; Embolization, Therapeutic; Equipment Contamination; Female; Humans; Imaging, Three-Dimensional; Infarction, Middle Cerebral Artery; Magnetic Resonance Imaging; Meningoencephalitis; Prostheses and Implants; Prosthesis-Related Infections; Tomography, X-Ray Computed

Topics: Acyclovir; Brain; Brain Edema; Craniotomy; Decompression, Surgical; Encephalitis, Herpes Simplex; Female; Herpesvirus 1, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Magnetic Resonance Imaging; Meningioma; Middle Aged; Postoperative Complications; Steroids; Stress, Physiological; Treatment Outcome; Unconsciousness