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Lin J, Zheng Y, Zhao N, Cui F, Wu S. Herpesvirus latent infection promotes stroke via activating the OTUD1/NF-κB signaling pathway. Aging (Albany NY) 2023; 15:8976-8992. [PMID: 37695739 PMCID: PMC10522389 DOI: 10.18632/aging.205011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE Our study aimed to reveal the molecular mechanisms underlying the regulation of cerebral infarction by herpes virus latency infection via the OTUD1/NF-κB signaling pathway using evidence-based medicine Meta-analysis and bioinformatics analysis. METHODS We conducted a Meta-analysis by searching Pubmed, Embase, and Web of Science databases to evaluate the correlation between herpes virus infection and increased risk of cerebral infarction. We obtained wild-type or mutant herpes virus latent infection-related brain tissue datasets from the GEO database and performed differential analysis to identify differentially expressed genes (DEGs) in the brain tissue after herpes virus latent infection. We further conducted WGCNA co-expression analysis on the cerebral infarction-related datasets from the GEO database to obtain key module genes and intersect them with the DEGs. We used ROC curve analysis to identify the key gene OTUD1 for predicting the occurrence of cerebral infarction and combined correlation and pathway enrichment analyses to identify the downstream pathways regulated by OTUD1. RESULTS Our meta-analysis revealed that herpes virus infection is associated with an increased risk of cerebral infarction. By integrating the differential analysis and WGCNA co-expression analysis of GEO chip data, we identified three key genes mediating cerebral infarction after herpes virus latent infection. ROC curve analysis identified the key gene OTUD1, and the correlation and pathway enrichment analyses showed that OTUD1 regulates the NF-κB signaling pathway to mediate cerebral infarction. CONCLUSION Herpes virus latent infection promotes cerebral infarction by activating the OTUD1/NF-κB signaling pathway.
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Affiliation(s)
- Jiacai Lin
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Yangrui Zheng
- Department of Neurosurgery, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Ning Zhao
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Fang Cui
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Siting Wu
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
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2
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Esin RG, Fatykhova AF, Esin OR. [Vasculitis as a cause of stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:5-11. [PMID: 38148691 DOI: 10.17116/jnevro20231231225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
The review considers the clinical picture, key aspects of the diagnosis and treatment of vasculitis that are the causes of strokes (giant cell arteritis, polyarteritis nodosa, varicella zoster virus vasculopathy, cerebrovascular pathology caused by herpes simplex virus types 1 and 2, primary CNS angiitis, adenosine deaminase-2 deficiency).
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Affiliation(s)
- R G Esin
- Kazan (Volga region) Federal University, Kazan, Russia
- Kazan State Medical Academy, Kazan, Russia
| | - A F Fatykhova
- Kazan (Volga region) Federal University, Kazan, Russia
| | - O R Esin
- Kazan (Volga region) Federal University, Kazan, Russia
- Clinic of Otorhinolaryngology, Kazan, Russia
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3
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Loskutov IA, Korsakova NV, Lyakhova EA, Poromov AA, Pshenichnaya NY, Maleev VV. [Ophthalmic manifestations of COVID-19]. Vestn Oftalmol 2023; 139:81-88. [PMID: 37942601 DOI: 10.17116/oftalma202313905181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
In March 2020 the World Health Organization (WHO) declared a pandemic of the novel coronavirus infection (COVID-19) caused by the SARS-CoV-2 respiratory virus. The high spread rate of the virus and the severity of the course of the disease are of great clinical and epidemiological significance, making it relevant for ophthalmologists to study the mechanisms of how SARS-CoV-2 infects ocular structures, as well as possible clinical manifestations of the infection in the organ of vision. This review contains analysis, systematization, and generalization of epidemiological and clinical data on SARS-CoV-2 ocular lesions and was carried out with the data found in scientific abstract databases. The article presents main clinical ophthalmic manifestations of COVID-19, lists the utilized schemes of etiotropic and symptomatic therapy, recommended preventive measures, and considers the possible ophthalmic complications after vaccination against COVID-19.
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Affiliation(s)
- I A Loskutov
- Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - N V Korsakova
- Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
- Cheboksary branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Cheboksary, Russia
| | | | - A A Poromov
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - N Yu Pshenichnaya
- Central Research Institute of Epidemiology, Moscow, Russia
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - V V Maleev
- Central Research Institute of Epidemiology, Moscow, Russia
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4
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Benjamin LA, Lim E, Sokolska M, Markus J, Zaletel T, Aggarwal V, Luder R, Sanchez E, Brown K, Sofat R, Singh A, Houlihan C, Nastouli E, Losseff N, Werring DJ, Brown MM, Mason JC, Simister RJ, Jäger HR. Vessel wall magnetic resonance and arterial spin labelling imaging in the management of presumed inflammatory intracranial arterial vasculopathy. Brain Commun 2022; 4:fcac157. [PMID: 35813881 PMCID: PMC9263889 DOI: 10.1093/braincomms/fcac157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/08/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Optimal criteria for diagnosing and monitoring response to treatment for infectious and inflammatory medium–large vessel intracranial vasculitis presenting with stroke are lacking. We integrated intracranial vessel wall MRI with arterial spin labelling into our routine clinical stroke pathway to detect presumed inflammatory intracranial arterial vasculopathy, and monitor disease activity, in patients with clinical stroke syndromes. We used predefined standardized radiological criteria to define vessel wall enhancement, and all imaging findings were rated blinded to clinical details. Between 2017 and 2018, stroke or transient ischaemic attack patients were first screened in our vascular radiology meeting and followed up in a dedicated specialist stroke clinic if a diagnosis of medium–large inflammatory intracranial arterial vasculopathy was radiologically confirmed. Treatment was determined and monitored by a multi-disciplinary team. In this case series, 11 patients were managed in this period from the cohort of young stroke presenters (<55 years). The median age was 36 years (interquartile range: 33,50), of which 8 of 11 (73%) were female. Two of 11 (18%) had herpes virus infection confirmed by viral nucleic acid in the cerebrospinal fluid. We showed improvement in cerebral perfusion at 1 year using an arterial spin labelling sequence in patients taking immunosuppressive therapy for >4 weeks compared with those not receiving therapy [6 (100%) versus 2 (40%) P = 0.026]. Our findings demonstrate the potential utility of vessel wall magnetic resonance with arterial spin labelling imaging in detecting and monitoring medium–large inflammatory intracranial arterial vasculopathy activity for patients presenting with stroke symptoms, limiting the need to progress to brain biopsy. Further systematic studies in unselected populations of stroke patients are needed to confirm our findings and establish the prevalence of medium–large artery wall inflammation.
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Affiliation(s)
- L A Benjamin
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
- Laboratory of Molecular and Cell Biology, UCL, Gower St, Kings Cross , London WC1E 6BT , UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
- University of Liverpool, Brain Infections Group, Liverpool , Merseyside, L69 7BE , UK
| | - E Lim
- Department of Imaging, University College London Hospitals NHS foundation trust , London, NW1 2PG , UK
| | - M Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust , London, NW1 2PG , UK
| | - J Markus
- Department of Imaging, University College London Hospitals NHS foundation trust , London, NW1 2PG , UK
| | - T Zaletel
- Department of Medicine, University of Cambridge , Cambridge, CB2 1TN , UK
| | - V Aggarwal
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
| | - R Luder
- Department of Medicine, North Middlesex University Hospital , London, N18 1QX , UK
| | - E Sanchez
- Department of clinical virology, University College London Hospitals NHS Foundation Trust , London, NW1 2PG , UK
| | - K Brown
- Department of Virology, UK Health Security Agency , London, NW9 5EQ , UK
| | - R Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool L69 7BE , UK
- Health Data Research , London, NW1 2BE , UK
| | - A Singh
- Department of Medicine, Royal Free Hospital Foundation Trust , London, NW3 2QG , UK
| | - C Houlihan
- Department of clinical virology, University College London Hospitals NHS Foundation Trust , London, NW1 2PG , UK
| | - E Nastouli
- Department of clinical virology, University College London Hospitals NHS Foundation Trust , London, NW1 2PG , UK
- Crick Institute , London, NW1 1AT , UK
| | - N Losseff
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
| | - D J Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
| | - M M Brown
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
| | - J C Mason
- Department of Medicine, Hammersmith Hospital , London, W12 0HS , UK
- National Heart and Lung Institute, Imperial College London , London, SW3 6LY , UK
| | - R J Simister
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
| | - H R Jäger
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
- Department of Imaging, University College London Hospitals NHS foundation trust , London, NW1 2PG , UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London , London, WC1N 3BG , UK
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Kargiotis O, Oikonomi K, Geka A, Psychogios K, Safouris A, Zis P, Kararizou E, Papadionisiou P, Tsivgoulis G. HSV-Encephalitis Resembling Acute Cerebral Infarction in a Patient With Atrial Fibrillation: Beware of Stroke Mimics. Neurologist 2021; 27:30-33. [PMID: 34842570 DOI: 10.1097/nrl.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Herpes simplex virus-1 (HSV-1) encephalitis, the most common and potentially life-threatening type of encephalitis, may rarely present as a stroke mimic. Prompt diagnosis is of paramount importance for the timely initiation of antiviral treatment and to avert intravenous thrombolysis. CASE REPORT A 60-year-old man with a history of lone paroxysmal atrial fibrillation without prior antithrombotic treatment was admitted due to mild gait unsteadiness and intermittent dysarthria of acute onset. On admission, the patient was afebrile, whereas neurological examination revealed only a mild pronator drift on the left. Brain magnetic resonance imaging (MRI) showed an extensive right temporo-occipital and thalamic lesion with restricted diffusion and 3 small-sized hemorrhagic foci. Brain MR-angiography did not show large vessel stenosis or occlusion. On the basis of careful observation and the depiction of several imaging discrepancies, such as early vasogenic edema and hemorrhagic transformation, as well as uncus involvement, but also the lack of significant neurological deficits despite the size of the brain lesion we suspected viral encephalitis which was confirmed by the detection of HSV-1 DNA in the cerebrospinal fluid. CONCLUSION HSV-encephalitis might occasionally result in the development of unilateral brain MRI lesions with extensive cytotoxic edema, resembling an acute ischemic stroke. Therefore, HSV-encephalitis must be considered in the differential diagnosis of acute ischemic stroke with atypical presentation. The presence of a significant dissociation between the brain MRI lesion volume and the neurological deficits, as well as certain brain MRI imaging discrepancies might serve as "red flags" to extend the diagnostic workup.
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Affiliation(s)
| | | | | | | | | | | | - Evangelia Kararizou
- First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National & Kapodistiran University of Athens, "Attikon" University Hospital, Athens, Greece
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6
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Wang Y, Feng F, Zheng P, Wang L, Wang Y, Lv Y, Shen L, Li K, Feng T, Chen Y, Liu Z, Yao Y. Dysregulated lncRNA and mRNA may promote the progression of ischemic stroke via immune and inflammatory pathways: results from RNA sequencing and bioinformatics analysis. Genes Genomics 2021; 44:97-108. [PMID: 34699043 PMCID: PMC8546200 DOI: 10.1007/s13258-021-01173-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long non-coding RNAs (lncRNAs) are widely involved in gene transcription regulation and which act as epigenetic modifiers in many diseases. OBJECTIVE To determine whether lncRNAs are involved in ischemic stroke (IS), we analyzed the expression profile of lncRNAs and mRNAs in IS. METHODS RNA sequencing was performed on the blood of three pairs of IS patients and healthy controls. Differential expression analysis was used to identify differentially expressed lncRNAs (DElncRNAs) and mRNAs (DEmRNAs). Based on the co-expression relationships between lncRNA and mRNA, a series of bioinformatics analysis including GO and KEGG enrichment analysis and PPI analysis, were conducted to predict the function of lncRNA. RESULTS RNA sequencing produced a total of 5 DElncRNAs and 144 DEmRNAs. Influenza A pathway and Herpes simplex infection pathway were the most significant pathways. EP300 and NFKB1 were the most important target proteins, and Human leucocyte antigen (HLA) family were the key genes in IS. CONCLUSIONS Analysis of this study revealed that dysregulated lncRNAs in IS may lead to IS by affecting the immune and inflammation system.
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Affiliation(s)
- Yingshuang Wang
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Feifei Feng
- Jilin Province of Jilin Combine Traditional Chinese and Western Medicine Hospital, Jilin, 132000, China
| | - Pingping Zheng
- Futian District Center for Disease Prevention and Control, Shenzhen, 518040, China
| | - Lijuan Wang
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, 130021, China
| | - Yanjun Wang
- Nursing Department, The Second Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yaogai Lv
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Li Shen
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Kexin Li
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Tianyu Feng
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Yang Chen
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Zhigang Liu
- Department of Pain Management, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin, China.
| | - Yan Yao
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China.
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Saberi A, Akhondzadeh S, Kazemi S, Kazemi S. Infectious Agents and Stroke: A Systematic Review. Basic Clin Neurosci 2021; 12:427-440. [PMID: 35154584 PMCID: PMC8817172 DOI: 10.32598/bcn.2021.1324.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 04/25/2020] [Accepted: 05/30/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: A major cause of injury and the second cause of death worldwide is stroke. Among several infectious agents considered as the risk factor of stroke, some pathogens demonstrated stronger robust associations with stroke. Proposing an accurate correlation between infectious microorganisms and stroke provides valuable information for early intervention and control of the infections. Methods: In this study, we searched the literature using the Web of Science, PMC/Medline via PubMed, and Scopus databases up to July 2018 without time and language restrictions. After quality assessment, 16 articles were included in the study. The whole data extraction process was independently conducted by two reviewers. Results: Based on the results of the studies, viruses, such as Hepatitis C virus (HCV), Hepatitis B virus (HBV), Human Immunodeficiency Virus (HIV), Herpes Simplex Virus Type-1, 2 (HSV-1, 2), Varicella-Zoster Virus (VZV or Chickenpox), and West Nile virus (WNV) seem to be common causes of ischemic stroke. Moreover, the association of other microbial categories, such as Streptococcus mutans (in bacteria), Toxocara spp. and Toxoplasma gondii (in parasites), and Rhizopus sp. (in fungi) with stroke was reported. Conclusion: Considering the adverse role of the above-mentioned microorganisms, it is necessary to implement some preventive measures for stroke treatment.
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Affiliation(s)
- Alia Saberi
- Department of Neurology, Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Kazemi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Kazemi
- Deputy of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran
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8
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The Foix-Chavany-Marie syndrome due to herpes symplex virus encephalitis type 2. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:483-486. [DOI: 10.1016/j.nrleng.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/26/2020] [Indexed: 11/19/2022] Open
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9
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Rodríguez Gascón D, Sancho-Saldaña A, Carilla Sanromán A, Bertol Alegre V. [The Foix-Chavany-Marie syndrome due to herpes symplex virus encephalitis type 2]. Neurologia 2020. [PMID: 33071016 DOI: 10.1016/j.nrl.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- D Rodríguez Gascón
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - A Sancho-Saldaña
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Carilla Sanromán
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - V Bertol Alegre
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
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10
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Sunkesula V, Danilewitz M. The Black Esophagus: A Rare Association. Gastroenterology 2020; 159:e8-e10. [PMID: 32311361 DOI: 10.1053/j.gastro.2020.03.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Venkata Sunkesula
- Department of Internal Medicine, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio; Department of Gastroenterology, Mercy Catholic Medical Center, Philadelphia, Pennsylvania.
| | - Mervyn Danilewitz
- Department of Gastroenterology, Mercy Catholic Medical Center, Philadelphia, Pennsylvania
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11
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Leal Rato M, Nunes Vicente B, da Cunha MR, Marques T, Aguiar de Sousa D, Canhão P. Herpes simplex virus 2 vasculitis as cause of ischemic stroke in a young immunocompromised patient. J Neurovirol 2020; 26:805-807. [PMID: 32839946 DOI: 10.1007/s13365-020-00894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
Herpes simplex virus 2 (HSV-2) is a very rare cause of central nervous system (CNS) infections. We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-2 DNA was identified by PCR, with a positive viral load in favor of active replication. No other viral or microbiological infections were identified. MRI angiography confirmed a vasculitic process involving the left carotid artery, and a HSV-2 vasculitis diagnosis was assumed. The patient started acyclovir with improvement of clinical features and imaging abnormalities. In the HIV-infected patient, stroke is a multifactorial common cause of morbidity. The physician should take into account a broad differential diagnosis including rare causes and atypical presentations of common etiologies, including HSV-1 and HSV-2 CNS infection.
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Affiliation(s)
- Miguel Leal Rato
- Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal. .,Faculdade de Medicina, Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Beatriz Nunes Vicente
- Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Maria Ribeiro da Cunha
- Serviço de Doenças Infecciosas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Tiago Marques
- Serviço de Doenças Infecciosas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Diana Aguiar de Sousa
- Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Patrícia Canhão
- Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal
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12
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Infections causing stroke or stroke-like syndromes. Infection 2020; 48:323-332. [PMID: 32239441 DOI: 10.1007/s15010-020-01415-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stroke has relevant morbidity and mortality despite appropriate treatments and early diagnosis. Beside common risk factors such as diabetes and atrial fibrillation, infections can be involved in stroke pathogenesis, probably causing a systemic release of cytokines and other inflammatory mediators, triggering a latent pro-thrombotic state or damaging the vascular endothelium. In other cases, infections can occur as stroke-like syndromes, requiring a high grade of suspicion to avoid a delay in establishing a correct diagnosis. RESULTS Treatment of stroke or stroke-like syndromes of infectious origin can be difficult. When a previous infective event triggers stroke, Alteplase administration can be associated with a higher incidence of bleeding and the extension of the ischaemic area can be major than expected. On the other hand, when stroke is part of some infectious diseases' presentation as in endocarditis, bacterial or tuberculous meningitis and meningo-vascular syphilis, a correct diagnosis can be difficult. The management of these stroke-like syndromes is not standardised because common treatments proven to be effective for patients with stroke of vascular origin can worsen the prognosis, as it can be demonstrated after to be incorrect Alteplase administration to patients with endocarditis with septic embolism to the brain is associated with an increase of the risk of haemorrhage. CONCLUSIONS Stroke or stroke-like syndrome of infectious origin can be observed in an important proportion of case presenting with sensory-motor deficit of unknown origin; their accurate diagnosis has a considerable impact in terms of treatment choices and outcome.
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13
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Herpes Simplex Virus Type 2 Encephalitis Presenting as Multifocal Hemorrhagic Stroke. Can J Neurol Sci 2020; 47:563-565. [PMID: 32188516 DOI: 10.1017/cjn.2020.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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14
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Erazo Narvaez AF, Díez Chamorro LS, Ordoñez Ruiz GA, Niño Castaño VE. Meningoencefalitis por herpes simple: una visión de la infección viral que causa el mayor compromiso cerebral. REPERTORIO DE MEDICINA Y CIRUGÍA 2020. [DOI: 10.31260/repertmedcir.01217273.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La inflamación del sistema nervioso central secundaria a la infección por la familia herpesviridae puede generar un compromiso difuso del parénquima encefálico, la cual puede ser fatal en ausencia de un rápido diagnóstico y tratamiento. Objetivo: revisar las diferentes características biológicas, fisiopatológicas, clínicas, terapéuticas y pronóstico de la meningoencefalitis causada por VHS-1 y 2. Materiales y métodos: revisión de la literatura científica (revisión crítica), llevada a cabo mediante las bases de datos Medline y buscadores específicos IMBIOMED, PUBMEDE, SCIENCEDIRECT, SCIELO, con un total de 150 artículos, se priorizaron 67 los cuales fueron leídos a profundidad. Resultados y discusión: debido el neurotropismo del herpes virus simple puede causar neuroinvasividad, neurotoxicidad y latencia en el SNC. Por sus características semiológicas inespecíficas se requiere un estudio exhaustivo para lograr el diagnóstico acertado. Los métodos actuales tales como neuroimágenes y PCR han aportado al esclarecimiento del diagnóstico etiológico de esta patología. La detección temprana de la entidad y la instauración precoz del tratamiento, se asocian con un aumento en la tasa de supervivencia y a una disminución de las secuelas neurológicas. Conclusión: conocer la biología del virus, su comportamiento, las características clínicas y el tratamiento de la entidad es una estrategia eficaz para disminuir secuelas y desenlaces fatales.
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Hauer L, Pikija S, Schulte EC, Sztriha LK, Nardone R, Sellner J. Cerebrovascular manifestations of herpes simplex virus infection of the central nervous system: a systematic review. J Neuroinflammation 2019; 16:19. [PMID: 30696448 PMCID: PMC6352343 DOI: 10.1186/s12974-019-1409-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/17/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage and ischemic stroke are increasingly recognized complications of central nervous system (CNS) infection by herpes simplex virus (HSV). AIM OF THE STUDY To analyze clinical, imaging, and laboratory findings and outcomes of cerebrovascular manifestations of HSV infection. METHODS Systematic literature review from January 2000 to July 2018. RESULTS We identified 38 patients (median age 45 years, range 1-73) comprising 27 cases of intracerebral hemorrhage, 10 of ischemic stroke, and 1 with cerebral venous sinus thrombosis. Intracerebral hemorrhage was predominantly (89%) a complication of HSV encephalitis located in the temporal lobe. Hematoma was present on the first brain imaging in 32%, and hematoma evacuation was performed in 30% of these cases. Infarction was frequently multifocal, and at times preceded by hemorrhage (20%). Both a stroke-like presentation and presence of HSV encephalitis in a typical location were rare (25% and 10%, respectively). There was evidence of cerebral vasculitis in 63%, which was exclusively located in large-sized vessels. Overall mortality was 21% for hemorrhage and 0% for infarction. HSV-1 was a major cause of hemorrhagic complications, whereas HSV-2 was the most prevalent agent in the ischemic manifestations. CONCLUSION We found a distinct pathogenesis, cause, and outcome for HSV-related cerebral hemorrhage and infarction. Vessel disruption within a temporal lobe lesion caused by HSV-1 is the presumed mechanism for hemorrhage, which may potentially have a fatal outcome. Brain ischemia is mostly related to multifocal cerebral large vessel vasculitis associated with HSV-2, where the outcome is more favorable.
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Affiliation(s)
- Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Slaven Pikija
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria
| | - Eva C. Schulte
- Department of Neurology, Friedrich-Baur Institute, University Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany
| | - Laszlo K. Sztriha
- Department of Neurology, King’s College Hospital, Denmark Hill, London, UK
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria
- Division of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Stroke Status Developed After Herpes Viridae Infection: A Report of Two Cases. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Lal A, Dhamne MC, Hui AC, Ahmad A. Herpes simplex virus (HSV) encephalitis in a young man: an unusual course. BMJ Case Rep 2018; 2018:bcr-2017-222499. [PMID: 29478004 DOI: 10.1136/bcr-2017-222499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We present a case of cerebral venous sinus thrombosis (CVST) as a rare complication of herpes simplex virus (HSV) encephalitis. A young man with no pertinent medical history was diagnosed with HSV encephalitis. After initial treatment, he showed improvement in symptomatology until day 6 when he acutely developed new neurological deficits. An urgent MRI brain showed changes in left temporal lobe consistent with HSV encephalitis and lack of flow void in superior sagittal sinus. Subsequent magnetic resonance venography confirmed the diagnosis of superior sagittal sinus thrombosis along with thrombosis of bilateral frontoparietal cortical draining veins. Anticoagulation was immediately initiated and oral anticoagulation was continued for 1 year. He made complete recovery subsequently. Our case serves as a reminder for the treating clinicians to consider CVST in patients with HSV encephalitis who develop an unexpected new neurological deficits during early phase of appropriate treatment.
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Affiliation(s)
- Amos Lal
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Megha C Dhamne
- Department of Medicine, Division of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Andrew C Hui
- Department of Medicine, Division of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Aftab Ahmad
- Department of Medicine, Division of Neurology, Ng Teng Fong General Hospital, Singapore
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Zhang F, Sumida A, Margolesky J, Tornes L, Ramos A, Koch S. HSV-2 encephalitis presenting as multifocal ischemic stroke. Neurol Sci 2017; 38:2229-2230. [PMID: 28861628 DOI: 10.1007/s10072-017-3100-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Fanglin Zhang
- Department of Neurology, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, 33136, USA.
| | - Ai Sumida
- Department of Neurology, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, 33136, USA
| | - Jason Margolesky
- Department of Neurology, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, 33136, USA
| | - Leticia Tornes
- Department of Neurology, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, 33136, USA
| | - Alberto Ramos
- Department of Neurology, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, 33136, USA
| | - Sebastian Koch
- Department of Neurology, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, 33136, USA.
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Modi S, Mahajan A, Dharaiya D, Varelas P, Mitsias P. Burden of herpes simplex virus encephalitis in the United States. J Neurol 2017; 264:1204-1208. [PMID: 28516331 DOI: 10.1007/s00415-017-8516-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/29/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Abstract
Herpes simplex virus encephalitis (HSVE) is a disease of public health concern, but its burden on the healthcare of United States has not been adequately assessed recently. We aimed to define the incidence, complications and outcomes of HSVE in the recent decade by analyzing data from a nationally representative database. Healthcare Cost and Utilization Project databases were utilized to identify patients with primary discharge diagnosis of HSVE. Annual hospitalization rate was estimated and several preselected inpatient complications were identified. Regression analyses were used to identify mortality predictors. Key epidemiological factors were compared with those from other countries. Total 4871 patients of HSVE were included in our study. The annual hospitalization rate was 10.3 ± 2.2 cases/million in neonates, 2.4 ± 0.3 cases/million in children and 6.4 ± 0.4 cases/million in adults. Median age was 57 years and male:female incidence ratio was 1:1. Rates of some central nervous system complications were seizures (38.4%), status epilepticus (5.5%), acute respiratory failure (20.1%), ischemic stroke (5.6%) and intracranial hemorrhage (2.7%), all of which were significantly associated with mortality. In-hospital mortality in neonates, children and adults were 6.9, 1.2 and 7.7%, respectively. HSVE still remains a potentially lethal infectious disease with high morbidity and mortality. Most recent epidemiological data in this study may help understanding this public health disease, and the patient outcome data may have prognostic significance.
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Affiliation(s)
- S Modi
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Abhimanyu Mahajan
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
| | - D Dharaiya
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - P Varelas
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - P Mitsias
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
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