acyclovir and Hemiplegia

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

Since the outbreak of novel influenza A (H1N1) in 2009, various neurological complications have been cited. We described a male patient with H1N1-associated encephalopathy/encephalitis presenting with severe neurological symptoms and signs. Residual neurological sequelae were dominant. This is the first report of extensive cortical-subcortical necroses over the bilateral frontal-parietal areas based on an MRI study.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Brain; Cerebral Angiography; Electroencephalography; Encephalitis; Hemiplegia; Humans; Hypnotics and Sedatives; Influenza A Virus, H1N1 Subtype; Influenza, Human; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Muscle Rigidity; Nervous System Diseases; Oseltamivir; Propofol; Tomography, X-Ray Computed; Tremor

Acute hemorrhagic leukoencephalitis (AHL) is a rare demyelinating disease mainly affecting children, characterized by acute onset, progressive course and high mortality. A 62-year-old man was admitted to our Unit for diplopia and ataxia ensuing 2 weeks after the onset of pneumonia. MRI T2-weighted images showed signal hyperintensities in the brainstem. Antibodies against Mycoplasma Pneumoniae and cold agglutinins were found. Two weeks later the patient had a worsening of his conditions: he developed left hemiplegia with motor focal seizures and the day after he was deeply comatose (GCS = 4). A second MRI scan showed extensive hyperintensities involving the whole right hemisphere white matter with a small parietal hemorrhagic area. The clinical and neuroimaging features suggested the diagnosis of AHL, Aciclovir in association with steroid therapy were administered and then plasmapheresis was started. After 30 days of coma, the patient gradually reacquired consciousness and motor functions; anyway a left hemiplegia persisted.

Topics: Acyclovir; Ataxia; Brain; Brain Stem; Cerebral Cortex; Coma; Disease Progression; Hemiplegia; Humans; Leukoencephalitis, Acute Hemorrhagic; Magnetic Resonance Imaging; Male; Middle Aged; Plasmapheresis; Pneumonia, Mycoplasma; Recovery of Function; Steroids; Treatment Outcome

Acute retinal necrosis syndrome (ARN syndrome) is a rare viral disease with a poor prognosis in most cases. It is characterized by substantial ocular inflammation with progressive retinal necrosis, occlusive vasculitis and sometimes extraocular features.. We report the case of a 62-year-old woman who was referred for a suspicion of a stroke. Ophthalmological examination revealed a profound bilateral visual loss due to extensive retinal necrosis. The patient was immediately treated with antiherpetic drugs. ARN syndrome with meningoencephalitis caused by herpes simplex virus type 2 was confirmed by PCR studies performed on aqueous humor and cerebrospinal fluid. Herpes simplex virus 2 (IgG+ , IgM-) was probably reactivated after intrathecal injection of steroids because of pain associated with narrowing of the lumbar vertebral canal. The patient was treated with intravenous Acyclovir for 3 weeks. After 4 months, both retinas were detached.. ARN syndrome caused by herpes simplex virus 2 most often occurs after reactivation of the latent virus in patients with a neurological medical history or congenital infection. Antiviral treatment must begin early to decrease risks of bilateralization and complications.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Cerebrospinal Fluid; Dexamethasone; Diagnostic Errors; DNA, Viral; Drug Therapy, Combination; Encephalitis, Herpes Simplex; Female; Ganciclovir; Hemiplegia; Herpesvirus 2, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Stroke; Urinary Incontinence; Virus Activation

A sixty-six year old female was admitted to the hospital with an incomplete hemiparesis on the left side combined with a short episode of unconsciousness. According to her husband's account she had a seizure. Relevant laboratory measurements: plasma sodium concentration 113.9 mmol/l, plasma concentration of ADH 10.3 pg/ml, urine sodium concentration 44.4 mmol/l. The plasma concentrations of creatinine and urea were within normal limits. The working hypothesis was SIAD (syndrome of inappropriate antidiuresis) or Schwartz-Bartter-syndrome. The patient was treated immediately with water restriction (500-1000 ml/day), furosemide and i.v. replacement of urinary sodium losses by 3% NaCl. The analysis of cerebrospinal fluid showed pleocytosis and increased concentrations of immunoglobulins G and M. Serological diagnosis was positive for antigen of varicella-zoster virus. These observations were thought to be compatible with a diagnosis of SIAD in the setting of encephalitis. Under water restriction, infusion of 3% saline, treatment with loop diuretics and aciclovir (3 x 750 mg daily) the neurological function returned to normal within 2 days. A standard oral water load on the 14th hospital days showed a return to a normal water metabolism.

Topics: Acyclovir; Aged; Antiviral Agents; Combined Modality Therapy; Diagnosis, Differential; Diuretics; Encephalitis, Viral; Female; Hemiplegia; Herpes Zoster; Herpesvirus 3, Human; Humans; Hyponatremia; Immunoglobulin G; Immunoglobulin M; Inappropriate ADH Syndrome; Unconsciousness

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Brain; Cerebrospinal Fluid; Child, Preschool; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Spectroscopy; Prednisone; Radiography

To suggest interim therapeutic guidelines for stroke following truncal herpes zoster on the basis of the first reported Australian case, in a patient who showed good clinical response related temporally to antiviral therapy.. A 70-year-old patient with no known underlying immune disorder presented with left-sided hemiplegia one week after right-sided truncal herpes zoster. In all probability the neurological deficit was due to large artery vasculopathy with thrombosis.. Clinical improvement (not to pre-morbid levels) was noted soon after commencement of antiviral therapy with acyclovir.. Stroke following herpes zoster may be a treatable condition. In view of the previously described occurrence of viral antigen within the walls of intracerebral vessels, the occasional progression of the syndrome over months, the generally low toxicity of acyclovir and the clinical response of the few patients treated with antiviral agents to date, early antiviral therapy in patients presenting with delayed contralateral hemiplegia associated with herpes zoster is recommended as prudent.

Topics: Acyclovir; Aged; Female; Hemiplegia; Herpes Zoster; Humans; Thorax

We report 31 cases of herpes zoster (HZ) with neurological complications: 14 with cranial nerve deficits, 1 with cranial nerve deficit associated with segmental motor disorder, 3 with segmental motor deficits, 2 with meningoencephalitis, 2 with meningoencephalitis associated with cranial neuropathy or myelitis, 2 with meningitis, 2 with hemiplegia contralateral to the ophthalmic HZ. 1 with hemiplegia and motor deficit and finally 1 with hemiplegia and a cranial neuropathy. Smoking was the putative risk factor in 53% of our patients together with diabetes, which has already been mentioned in the literature. We frequently observed more than one complication in succession (19.3%) that could not easily be related to the cutaneous distribution. Acyclovir had no demonstrable positive effects on neurological complication in our patients.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Cranial Nerve Diseases; Diabetes Complications; Female; Hemiplegia; Herpes Zoster; Humans; Hypertension; Male; Meningoencephalitis; Middle Aged; Risk Factors; Smoking

Topics: Acyclovir; Churg-Strauss Syndrome; Female; Hemiplegia; Herpes Zoster; Humans; Methylprednisolone; Middle Aged; Neuralgia

A 64 year-old woman experienced, at 6 weeks' interval, two episodes of encephalitis with left hemiparesis, coma and signs of meningitis. Paraclinical examinations showed lymphocytic meningitis, right temporal hypodensity at CT and high titers for herpes simplex at blood serology. The spontaneous course was favourable with almost complete recovery. A third recurrence took place 2 months later with left hemiplegia, confusion and meningism. A tentative diagnosis of herpes simplex encephalitis was confirmed by major intrathecal synthesis of herpes virus specific antibodies and by highly suggestive MRI images. Treatment with acyclovir resulted in rapid regression of motor deficit and meningism, but neuropsychological disorders regressed more slowly with persistent visuo-constructive and memory disorders. During a fourth and milder recurrence, a stereotactic temporal brain biopsy was performed, which showed lesions of encephalitis and elevated titers for HSV1 in the temporal fluid. Another course of acyclovir followed by vidarabine produced complete remission. The possibility of recurrent types of herpes simplex encephalitis is discussed.

Topics: Acyclovir; Coma; Encephalitis; Female; Hemiplegia; Herpes Simplex; Humans; Meningitis, Viral; Middle Aged; Recurrence; Serologic Tests; Stereotaxic Techniques; Vidarabine

A 57-year-old patient nonimmunosuppressed who had zoster ophthalmicus associated to contralateral hemiplegia is presented. We noticed on the CT scan an infarction of left caudate nucleus, as well as in the angiography signs of vasculitis. We comment on the clinical and diagnosis features and suggest possible benefit effects of the treatment with acyclovir.

Topics: Acyclovir; Brain; Cerebral Infarction; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Tomography, X-Ray Computed

Topics: Acyclovir; Child; Hemiplegia; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Male; Prognosis

Topics: Acyclovir; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Time Factors

A 17-month-old boy developed herpes zoster ophthalmicus (HZO) and delayed contralateral hemiparesis following intrauterine varicella exposure. CT demonstrated multiple areas of hypodensity in the left basal ganglia, and angiography showed occlusion of left lenticulostriate arteries. As in most adults with HZO and delayed hemiparesis, this infant had a self-limiting course with excellent recovery.

Topics: Acyclovir; Basal Ganglia; Chickenpox; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Infant; Male; Pregnancy; Pregnancy Complications, Infectious; Prenatal Exposure Delayed Effects; Radiography

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

Four patients with herpes zoster ophthalmicus and delayed contralateral hemiparesis are described, and their findings are compared with those in patients previously reported in the English language literature. The current patients evidenced multifocal ipsilateral cerebral angiitis by angiography and multifocal infarcts in the distribution of the ipsilateral middle cerebral artery by computed tomographic scanning. Cerebrospinal fluid showed mononuclear pleocytosis, positive oligoclonal bands, and an elevated immunoglobulin G index. Two patients were treated with corticosteroids and acyclovir, and 1 with corticosteroids alone, all without apparent response. Necrotizing angiitis ipsilateral to the herpes zoster ophthalmicus was demonstrated postmortem in 1 patient with multifocal cerebral infarction and progressive leukoencephalopathy. Neither herpes varicella zoster immunocytochemical reactivity nor viral inclusions were seen. The leukoencephalopathy associated with herpes varicella zoster either may be caused by cerebral angiitis or, as previously reported, may be a temporally remote manifestation of persistent herpes varicella zoster infection. The cerebral angiitis associated with herpes varicella zoster is histologically similar to granulomatous angiitis, and both may be related to herpes varicella zoster infection of the cerebral vasculature.

Topics: Acyclovir; Aged; Brain; Cerebral Arterial Diseases; Cerebral Infarction; Dexamethasone; Dominance, Cerebral; Electroencephalography; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prednisone; Tomography, X-Ray Computed; Vasculitis