phenylephrine-hydrochloride and Encephalitis

Autoimmune encephalitis (AE) is being increasingly recognized as a cause of new-onset movement disorders. Movement disorders in AE are diverse and range from hyperkinetic conditions such as oromandibular dyskinesias, tremors and chorea to hypokinetic ones such as bradykinesia and parkinsonism. Stereotypies have been described in association with anti-NMDAR encephalitis. Similarly, sleep dysfunction is an underrecognized feature in many AE subtypes, prominently anti-IgLON5 although the correlation of phenotype of sleep dysfunction with a particular antibody subtype in AE is unclear. Despite the recognition of both these features as part of an overreaching spectrum in any patient with AE, seldom are they the sole presenting manifestations. Additionally, the challenge is further compounded in a patient who has seronegative AE since neither sleep disturbances nor stereotypies have been well characterized with this condition yet, and the diagnosis is conditional to exhausting a list of ancillary supportive features. In this brief communication, we describe the case of a young man who presented with hypersomnolence and an unusual focal nose-pinching stereotypy of subacute onset who lacked the presence of other typical clinical characteristics such as cognitive/memory impairment and seizures and had negative autoimmune antibodies but responded to immune therapy dramatically. We propose that the presence of de novo hypersomnolence and stereotypy should inform a potential diagnosis of AE.

Topics: Encephalitis; Hashimoto Disease; Humans; Male; Nose; Sleepiness; Stereotypic Movement Disorder; Young Adult

Topics: Encephalitis; Humans; Nose

Herpes simplex virus type 2 (HSV-2), a ubiquitous human pathogen associated with genital infections, is neurotropic. It establishes latent infections in local dorsal root ganglia from which it reactivates causing recurrent lesions and frequent episodes of viral shedding. Herpes simplex virus type 2 can also be transmitted from mother to child during birth, causing major neonatal complications including encephalitis. Animal models of HSV-2 genital infection are well described and used for testing of therapies; little is known about animal models of HSV-2-induced encephalitis. We analyzed the pathologic and immunohistochemical features of the nasal rostrum and brain tissue and correlated them with viral distribution in a mouse model of HSV-2 encephalitis induced by intranasal infection and examined viral replication in the brain tissue using quantitative polymerase chain reaction and traditional plaque assay. Our results suggest that the primary route for HSV-2 neuroinvasion after intranasal infection is via the trigeminal pathway, ultimately leading to infection of the brainstem and meningoencephalitis.

Topics: Animals; Brain Stem; Disease Models, Animal; Encephalitis; Female; Herpesvirus 2, Human; Humans; Mice; Mice, Inbred BALB C; Nose; Time Factors; Trigeminal Ganglion; Viral Plaque Assay; Viral Proteins; Virus Replication

Granulomatous amebic encephalitis is an uncommon central nervous system (CNS) infection, usually caused by Acanthamoeba spp., which generally occurs in immunocompromised individuals. Balamuthia mandrillaris is a recently described free-living ameba that occasionally causes fatal CNS disease. The infection might start from a minor, slowly progressive, skin ulceration that can be present for weeks to months before neurologic changes occur. The clinical and histologic presentation is easily confused with many other diseases. Accurate diagnosis requires an awareness of this unusual presentation of amebiasis and identification of the amebic trophozoites in tissue and culture. Special stains are helpful, but immunofluorescence assays or electron microscopy is required to identify the organism as B mandrillaris. We present a fatal case of granulomatous amebic encephalitis that began as a cutaneous infection in an immunocompetent host.

Topics: Aged; Aged, 80 and over; Amebiasis; Amoeba; Animals; Diagnosis, Differential; Encephalitis; Fatal Outcome; Granuloma; Humans; Magnetic Resonance Imaging; Male; Necrosis; Nose; Skin Diseases, Parasitic

A case of life-threatening Chlamydia TWAR pneumonia complicated by encephalitis in a young, previously healthy adult is described. The patient presented with full blown adult respiratory distress syndrome and required prolonged ventilatory support and rigorous antibiotic and supportive care. He recovered fully without any neurologic sequelae. Chlamydia pneumoniae pneumonia should be included in the differential diagnosis of the severe community acquired pneumonia, because if properly sought and adequately treated, may have an excellent outcome.

Topics: Adult; Anti-Bacterial Agents; Chlamydia Infections; Chlamydophila pneumoniae; Community-Acquired Infections; Diagnosis, Differential; Disease-Free Survival; Encephalitis; Humans; Male; Nose; Pneumonia, Bacterial; Respiration, Artificial; Respiratory Distress Syndrome; Tachycardia

Intranasally administered alpha/beta interferon blocked extension of the coronavirus, mouse hepatitis virus, strain JHM (MHV-JHM), from the nose to the brain of BALB/cByJ mice following intranasal inoculation with the virus. Two hundred units of alpha/beta interferon were administered intranasally to BALB/cByJ mice daily over a five day period. The mice were exposed intranasally to 10(3) median tissue culture infectious doses of MHV-JHM on the third day of interferon treatment. Two days after virus exposure, the proportion of mice with MHV in nasal turbinates was reduced from 10 of 10 in the untreated group to 7 of 10 in the interferon-treated group, and mean titers in virus-containing noses were lower in the interferon-treated group. Five days after virus exposure, the proportion of mice with infectious virus in the brain was significantly lower in the interferon-treated group (1 of 10 mice) than in the untreated group (10 of 10 mice). Systemic infection, as measured by presence and concentration of virus in the spleen, was not affected by intranasal interferon treatment. These results suggest that intranasally administered interferon protects against local extension of MHV-JHM from nose to brain, but not against dissemination of virus to other organs, such as the spleen.

Topics: Administration, Intranasal; Animals; Brain; Encephalitis; Hepatitis, Viral, Animal; Interferon Type I; Mice; Mice, Inbred BALB C; Murine hepatitis virus; Nose

Topics: Adenoviridae; Antibodies; Antigens, Viral; Biopsy; Brain; Cells, Cultured; Cerebrospinal Fluid; Conjunctivitis; Encephalitis; Fluorescent Antibody Technique; Humans; Influenza A virus; Nose; Respiratory Syncytial Viruses; Simplexvirus; Trachea; Virus Diseases

Topics: Adult; Brain Neoplasms; Central Nervous System Diseases; Encephalitis; Eyebrows; Humans; Male; Movement Disorders; Neurologic Manifestations; Nose

Topics: Animal Feed; Animals; Bacteriological Techniques; Brain; Carrier State; Deer; Encephalitis; Feces; Food Microbiology; Illinois; Listeria monocytogenes; Listeriosis; Liver; Mice; Nose; Rodent Diseases; Serotyping; Sheep; Sheep Diseases; Spleen