Herpes simplex virus myelitis: clinical manifestations and diagnosis by the polymerase chain reaction method.
Herpes simplex virus (HSV) myelitis has previously been reported to be a form of acute ascending necrotizing myelitis caused by HSV type 2 (HSV-2). We studied neurological symptoms, clinical course, magnetic resonance imaging (MRI) findings, and diagnosis by polymerase chain reaction (PCR) methods in 9 patients with HSV myelitis. In 6 cases, disease onset was marked by sensorimotor disturbances of lower extremities and urinary disturbances, with the transverse myelopathy gradually ascending to the cervicothoracic spinal cord level. The other 3 cases showed transverse myelopathy without an ascending pattern. Six cases showed acute progression, while 3 cases showed a subacute course. There were 2 cases with recurrent episodes. Three patients recovered, however, in the remaining 6 patients severe sequelae such as paraplegia persisted despite antiviral therapy. MRI showed a hyperintense lesion on T2-weighted images. Gadolinium enhancement was observed in 2 cases, and 1 case showed a hyperintense lesion both on T1- and on T2-weighted images, suggesting hemorrhagic necrosis. HSV-2 was detected by PCR techniques in all 6 cases with an ascending pattern. HSV-1 DNA was detected in 2 and HSV-2 DNA in 1 of the 3 cases with a nonascending pattern. Our findings demonstrate diverse clinical manifestations of HSV myelitis.
Nakajima
H
H
First Department of Internal Medicine, Osaka Medical College, Takatsuki City, Japan.
Furutama
D
D
Kimura
F
F
Shinoda
K
K
Ohsawa
N
N
Nakagawa
T
T
Shimizu
A
A
Shoji
H
H
D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000134:cerebrospinal fluid; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis*; D018258:Herpesvirus 2, Human / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007124:Immunoenzyme Techniques; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000134:cerebrospinal fluid / Q000503:physiopathology / Q000821:virology*; D016133:Polymerase Chain Reaction; D013116:Spinal Cord / Q000473:pathology
D000914:Antibodies, Viral