Difference between revisions of "IPLab:Lab 8:HSV Encephalitis"

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== Clinical Summary ==
 
== Clinical Summary ==
  
This 30-year-old white male experienced a generalized tonic-clonic seizure and was subsequently started on a course of Dilantin. He did well, but later developed a headache lasting over a week, which was associated with tonic-clonic seizures, fever, and--toward the end of this period--ataxia. The patient improved and returned to work, but the headache returned. A lumbar puncture was then performed which showed 22 cells/cmm (all lymphocytes), protein of 88 grams/L, and a glucose level of 49 mg/dL (with a simultaneous serum glucose of 83 mg/dL). These findings were compatible with a viral infection. Despite therapy, the patient had another seizure and again developed fever. At that time, a brain biopsy was performed which showed herpetic encephalitis. Despite aggressive antiviral therapy the patient died.  
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This 30-year-old white male experienced a generalized tonic-clonic seizure and was subsequently started on a course of Dilantin. He did well, but later developed a headache lasting over a week, which was associated with tonic-clonic seizures, fever, and--toward the end of this period--ataxia. The patient improved and returned to work, but the headache returned. A lumbar puncture was then performed which showed 22 cells/mm³ (all lymphocytes), protein of 88 grams/L, and a glucose level of 49 mg/dL (with a simultaneous serum glucose of 83 mg/dL). These findings were compatible with a viral infection. Despite therapy, the patient had another seizure and again developed fever. At that time, a brain biopsy was performed which showed herpetic encephalitis. Despite aggressive antiviral therapy the patient died.
  
 
== Images ==
 
== Images ==
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IPLab8HSVEncephalitis12.jpg|This is a photomicrograph of a brain section stained with an antibody against herpes simplex. Even at this magnification, it is easy to pick out cells that are positive for the virus (arrows).  
 
IPLab8HSVEncephalitis12.jpg|This is a photomicrograph of a brain section stained with an antibody against herpes simplex. Even at this magnification, it is easy to pick out cells that are positive for the virus (arrows).  
 
</gallery>
 
</gallery>
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== Virtual Microscopy ==
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<peir-vm>IPLab8HSVEncephalitis</peir-vm>
  
 
== Study Questions ==
 
== Study Questions ==
 
* <spoiler text="What age groups are susceptible to herpetic encephalitis?">HSV-1 (labialis) produces encephalitis in any age group but is most common in children and young adults. Only about 10% of the patients have a history of prior labial herpes.</spoiler>
 
* <spoiler text="What age groups are susceptible to herpetic encephalitis?">HSV-1 (labialis) produces encephalitis in any age group but is most common in children and young adults. Only about 10% of the patients have a history of prior labial herpes.</spoiler>
 
* <spoiler text="What type of injury is produced by herpetic encephalitis, what areas of the brain are affected, and what are the most common clinical presenting signs/symptoms?">Encephalitis usually involves the inferior and medial regions of the temporal lobes and the orbital gyri of the frontal lobes. The infection is grossly necrotizing and often hemorrhagic with perivascular inflammatory infiltrates and Cowdry intranuclear viral inclusion bodies in both neurons and glia. The most commonly observed clinical presenting symptoms are alterations in mood, memory, and behavior.</spoiler>
 
* <spoiler text="What type of injury is produced by herpetic encephalitis, what areas of the brain are affected, and what are the most common clinical presenting signs/symptoms?">Encephalitis usually involves the inferior and medial regions of the temporal lobes and the orbital gyri of the frontal lobes. The infection is grossly necrotizing and often hemorrhagic with perivascular inflammatory infiltrates and Cowdry intranuclear viral inclusion bodies in both neurons and glia. The most commonly observed clinical presenting symptoms are alterations in mood, memory, and behavior.</spoiler>
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== Additional Resources ==
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=== Reference ===
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* [http://emedicine.medscape.com/article/218580-overview eMedicine Medical Library: Herpes Simplex]
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* [http://emedicine.medscape.com/article/783113-overview eMedicine Medical Library: Herpes Simplex in Emergency Medicine]
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* [http://emedicine.medscape.com/article/1165183-overview eMedicine Medical Library: Herpes Simplex Encephalitis]
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* [http://www.merckmanuals.com/professional/infectious_diseases/herpesviruses/herpes_simplex_virus_hsv_infections.html Merck Manual: Herpes Simplex Virus (HSV) Infections]
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* [http://www.merckmanuals.com/professional/neurologic_disorders/brain_infections/encephalitis.html Merck Manual: Encephalitis]
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=== Journal Articles ===
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* Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW; American College of Emergency Physicians.  [http://www.ncbi.nlm.nih.gov/pubmed/18809105 Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache].  ''Ann Emerg Med'' 2008 Oct;52(4):407-36.
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* Thomson RB Jr, Bertram H.  [http://www.ncbi.nlm.nih.gov/pubmed/11780267 Laboratory diagnosis of central nervous system infections].  ''Infect Dis Clin North Am'' 2001 Dec;15(4):1047-71.
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=== Images ===
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* [{{SERVER}}/library/index.php?/tags/127-herpes PEIR Digital Library: Herpes Images]
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* [http://library.med.utah.edu/WebPath/CNSHTML/CNSIDX.html#6 WebPath: CNS Infections]
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== Related IPLab Cases ==
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* [[IPLab:Lab 8:HSV Glossitis|Lab 8: Herpes Glossitis]]
  
 
{{IPLab 8}}
 
{{IPLab 8}}
  
 
[[Category: IPLab:Lab 8]]
 
[[Category: IPLab:Lab 8]]

Latest revision as of 16:28, 3 January 2014

Clinical Summary[edit]

This 30-year-old white male experienced a generalized tonic-clonic seizure and was subsequently started on a course of Dilantin. He did well, but later developed a headache lasting over a week, which was associated with tonic-clonic seizures, fever, and--toward the end of this period--ataxia. The patient improved and returned to work, but the headache returned. A lumbar puncture was then performed which showed 22 cells/mm³ (all lymphocytes), protein of 88 grams/L, and a glucose level of 49 mg/dL (with a simultaneous serum glucose of 83 mg/dL). These findings were compatible with a viral infection. Despite therapy, the patient had another seizure and again developed fever. At that time, a brain biopsy was performed which showed herpetic encephalitis. Despite aggressive antiviral therapy the patient died.

Images[edit]

Virtual Microscopy[edit]

Study Questions[edit]


Additional Resources[edit]

Reference[edit]

Journal Articles[edit]

Images[edit]

Related IPLab Cases[edit]

A tonic-clonic seizure involves loss of consciousness followed by tonic, then clonic, convulsions.

A tonic-clonic seizure involves loss of consciousness followed by tonic, then clonic, convulsions.

A normal number of cells in CSF is <4 lymphocytes per mm³.

A normal protein level for CSF should be < 0.4 grams/L.

A normal CSF glucose level should be approximately 70% of the patient's serum glucose level.

An infiltrate is an accumulation of cells in the lung parenchyma--this is a sign of pneumonia.