The clinical features and course of the condition, the associated auto-antibodies against relevant antigens, and the response to treatment all suggest that Bickerstaff’s encephalitis is an autoimmune disease. Therefore, the current consensus is that the two diseases are in fact part of a spectrum of autoimmune disease variably involving the PNS and CNS. J Neurol 2008; 255: 674–682. In our presented case, pons and cerebellar lesions could explain ophthalmoplegia, hyperreflexia, altered consciousness, and ataxia. Deep tendon reflexes were present, but reduced in all 4 limbs. Unusual and rare features in our case were an association of blepharospasm and brainstem encephalitis with Kikuchi-Fujimoto disease. Patients who were treated late (n = 2) or untreated (n = 1) had either a poorer outcome or persistence of symptoms.
Campylobacter jejuni was isolated from the stool culture and further evidence of a resolving infection was confirmed with serologic markers (positive IgM and IgG). We thank Dr Masaki Takahashi (Department of Microbiology, Tokyo Metropolitan Research Laboratory of Public Health) for theC jejuni serotyping and Dr Michiaki Koga (Department of Neurology, Dokkyo University School of Medicine) for the anti-C jejuni antibody measurements. Figure 2: MRI brain showing increased T2 FLAIR signal in brainstem. Neurological involvement is rare in Kikuchi-Fujimoto disease. The GQ1b/GM1 antibody panel was sent and returned negative for antibodies. 42:647-56. Protein concentration is typically normal to minimally elevated with viral encephalitis but may be significantly elevated with other organisms, in particular with bacterial or tuberculous meningoencephalitis.
Serum transaminase values were elevated in 11 patients, and exceeded 4 times the normal in 3. One patient had a single-documented episode of non-sustained ventricular tachycardia, but no other supraventricular or ventricular tachyarrhythmias were identified. Some types of scientific research simply do not yield to quantitative or statistical techniques. Expanded spectrum of herpes simplex encephalitis in childhood. The involvement of hippocampus and subcortical white matter has also been described in rabies, which were absent in our case. The postmortem corneal smear positivity for rabies antigen clinched the diagnosis in this case. However, CSF HSV PCR assays are typically negative in patients with more typical relapsed disease within the first 4 months of HSE. The neuropathology – at least in adults – is not suggestive of post-viral demyelination.
FBDS are characteristic of LGI1 autoimmunity and may precede other symptoms of the disease by weeks or months. In the focal area there were stated irregular areas of enhancement after injection of the contrast medium and a slight mass effect, with a slight pressure on the fourth ventricle. He was administrated immunoglobulin 1 gm/kg/day for 2 days and methylprednisolone pulse therapy. Objective data including bacterial culture, Gram’s stain, serology on CSF samples, level of CSF protein and sugar, and CSF cell and differential counts were obtained from patients’ clinical records. Likewise the rectum polyp exhibits the same histological (e) and immunohistochemical features including low proliferation (f) and marked reaction for the neuroendocrine markers chromogranin A and synaptophysin (g and h). Stomach and intestine were unaltered. Distal median sensory nerve conduction velocities were not measurable.
Abbreviations: R, right; L, left; DTR, deep tendon reflex; G, grade; IVIG, intravenous immunoglobulin; MethylPRD, methylprednisolone. trigeminal or spinal ganglia) can be found. In severe cases, there was involvement of the ventral horns of the spinal cord and the deep supratentorial nuclei. CAT scan showed diffuse high density areas in the bilateral temporal lobes. The infection may then cause a gradual decrease in awareness. Herpes simplex virus (HSV) encephalitis has a predilection for the temporal and frontal lobes but occasionally affects the brainstem. People are urged to get the shot after they turn 60 and not to wait until they are debilitated.
Meanwhile he started complaining of mild vertigo, and breathlessness on exertion. These GBS syndromes were predominantly characterized by axonal damage. Transverse myelitis can be recurrent, but other diseases can also cause recurrent cord symptoms. In very rare occasions, infection is limited to the brainstem and in these cases, cranial nerves abnormalities are the main manifestations 1, 7. Most authors now use the terms “rhombencephalitis” and “brainstem encephalitis” interchangeably even though anatomically they are slightly different. Duarte J,Argente J,Gutierrez P,et al.Herpes simplex brainstem encephalitis with a relapsing course.J Neurol,1994,241:401-403. Certain neurotropic viruses, such as herpes simplex replicate, in all types of CNS cell.
Tell a friend about us, add a link to this page, or visit the webmaster’s page for free fun content. MSG-01: A Randomized, Double-Blind, Placebo-Controlled Trial of Caspofungin Prophylaxis Followed by Preemptive Therapy for Invasive Candidiasis in High-Risk Adults in the Critical Care Setting. The incidence of herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) in herpes simplex encephalitis (HSE) was investigated using cerebrospinal fluid (CSF) samples from sixty-four cases of HSE. D’Alessandro V, Muscarella LA, Copetti M, Zelante L, Carella M, Vendemiale G. We report a patient with a relapsing form of acute brainstem encephalitis.