[A case of brainstem encephalitis caused by herpes simplex virus type 1 with possible infection via trigeminal nerve].
A 24-year-old man was admitted to our hospital because of consciousness disturbance, a stiff neck and various brainstem symptoms including a right one-and-a-half syndrome and right peripheral facial palsy a week after an episode of pharyngitis and right facial herpes simplex. Magnetic resonance imaging of the brain on admission showed high-signal intensities in the right pontine tegmentum, right cerebellar peduncle and vermis on fluid-attenuated inversion recovery imaging. Examination of cerebrospinal fluid yielded mononuclear pleocytosis, elevated protein and increased IgM antibodies to herpes simplex virus (HSV) by enzyme immunoassay. HSV-1 specific antibodies also were detected in serum by neutralization test. We gave a diagnosis of brainstem encephalitis caused by HSV-1. The patient was successfully treated with high dose of acyclovir, steroid and intravenous immunoglobulin. He was discharged without any neurologic sequelae. We herein presented a case of atypical encephalitis due to HSV-1 involving mainly the brainstem with possible infection via right trigeminal nerve and summarized recent 35 cases with herpetic brainstem encephalitis since 1990.
Yoshidome
Yoshito
Y
Department of Neurology, Imakiire General Hospital.
Hayashi
Shigeaki
S
Maruyama
Yoshikazu
Y
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D020330:Bell Palsy / Q000209:etiology; D001933:Brain Stem / Q000473:pathology*; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy; D018259:Herpesvirus 1, Human; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020433:Trigeminal Nerve Diseases / Q000150:complications / Q000821:virology*
D000998:Antiviral Agents; D000212:Acyclovir