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Wang Y, Wang S, Qiu T, Xiao Z. Photophobia in headache disorders: characteristics and potential mechanisms. J Neurol 2022; 269:4055-4067. [PMID: 35322292 DOI: 10.1007/s00415-022-11080-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 01/23/2023]
Abstract
Photophobia is present in multiple types of headache disorders. The coexistence of photophobia and headache suggested the potential reciprocal interactions between visual and pain pathways. In this review, we summarized the photophobic characteristics in different types of headache disorders in the context of the three diagnostic categories of headache disorders: (1) primary headaches: migraine, tension-type headache, and trigeminal autonomic cephalalgias; (2) secondary headaches: headaches attributed to traumatic brain injury, meningitis, non-traumatic subarachnoid hemorrhage and disorder of the eyes; (3) painful cranial neuropathies: trigeminal neuralgia and painful optic neuritis. We then discussed potential mechanisms for the coexistence of photophobia and headache. In conclusion, the characteristics of photophobia are different among these headache disorders. The coexistence of photophobia and headache is associated with the interactions between visual and pain pathway at retina, midbrain, thalamus, hypothalamus and visual cortex. The communication between these pathways may depend on calcitonin gene-related peptide and pituitary cyclase-activating polypeptide transmission. Moreover, cortical spreading depression, an upstream trigger of headache, also plays an important role in photophobia by increased nociceptive input to the thalamus.
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Affiliation(s)
- Yajuan Wang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Shaoyang Wang
- Department of Emergency, Rizhao People's Hospital, Rizhao, 276800, Shandong, China
| | - Tao Qiu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Zheman Xiao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
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Identification of Cerebrospinal Fluid Metabolites as Biomarkers for Enterovirus Meningitis. Int J Mol Sci 2019; 20:ijms20020337. [PMID: 30650575 PMCID: PMC6359617 DOI: 10.3390/ijms20020337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 01/08/2023] Open
Abstract
Enteroviruses are among the most common causes of viral meningitis. Enteroviral meningitis continues to represent diagnostic challenges, as cerebrospinal fluid (CSF) cell numbers (a well validated diagnostic screening tool) may be normal in up to 15% of patients. We aimed to identify potential CSF biomarkers for enteroviral meningitis, particularly for cases with normal CSF cell count. Using targeted liquid chromatography-mass spectrometry, we determined metabolite profiles from patients with enteroviral meningitis (n = 10) and subdivided them into those with elevated (n = 5) and normal (n = 5) CSF leukocyte counts. Non-inflamed CSF samples from patients with Bell’s palsy and normal pressure hydrocephalus (n = 19) were used as controls. Analysis of 91 metabolites revealed considerable metabolic reprogramming in the meningitis samples. It identified phosphatidylcholine PC.ae.C36.3, asparagine, and glycine as an accurate (AUC, 0.92) combined classifier for enterovirus meningitis overall, and kynurenine as a perfect biomarker for enteroviral meningitis with an increased CSF cell count (AUC, 1.0). Remarkably, PC.ae.C36.3 alone emerged as a single accurate (AUC, 0.87) biomarker for enteroviral meningitis with normal cell count, and a combined classifier comprising PC.ae.C36.3, PC.ae.C36.5, and PC.ae.C38.5 achieved nearly perfect classification (AUC, 0.99). Taken together, this analysis reveals the potential of CSF metabolites as additional diagnostic tools for enteroviral meningitis, and likely other central nervous system (CNS) infections.
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Shyshov AS, Bazarova MV, Blank IA, Pasyshnyuk EP, Savrasova NM, Shurenkova EN, Podkolzin AT. [Enterovirus infections and meningitis in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 116:9-15. [PMID: 27029441 DOI: 10.17116/jnevro2016116219-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare clinical characteristics in children with enterovirus infections (EVI) and meningitis with detailed characteristics of the changes in the content of cerebrospinal fluid (CSF) confirmed in the laboratory. MATERIAL AND METHODS The results of examinations of 97 children, aged from 2.5 to 15 years, 3 adolescents and 1 adult female patient with EVI were analyzed. Enterovirus RNA isolation and detection in feces and CSF was performed using PCR. RESULTS AND CONCLUSION Enterovirus RNA in CSF was detected in 44 children, including 3 patients with cytosis (5-7-19 cells in 3 mm3). The frequency and severity of symptoms in 42 patients with EVI and meningitis, 14 children with EVI without meningitis and 8 patients with ICD-10 «Meningitis unspecified» are presented. The initial CSF pleocytosis in 1-3 day (4-5 day for two-wave course) in EVI and meningitis was <100 in 4, from 100 to 1000 in 33, >1000 (max 3036) cells in 3 mm3 in 5 patients, including 15 with the predominance of neutrophils (from 77 to 97% in cytosis 114-2300 cells in 3 mm(3)). In the peripheral blood, leukocytosis 10.9-13.8×10(9)/л was noted in 12 children and leukocytosis 14.4-18.7×10(9)/л with the «left shift» in 7. Most of the children (n=37) with EVI and meningitis were discharged from the hospital within 10-17 days. The authors suggest the importance of including the variety of clinical presentations of EVI in the additional item «B10 Enterovirus infections» in upcoming ICD-11.
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Affiliation(s)
- A S Shyshov
- Chumakov Institute of Poliomyelitis and Viral Encephalitis, Moscow
| | | | - I A Blank
- Infectious clinical hospital 1, Moscow
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Kaminski M, Grummel V, Hoffmann D, Berthele A, Hemmer B. The spectrum of aseptic central nervous system infections in southern Germany - demographic, clinical and laboratory findings. Eur J Neurol 2017. [PMID: 28636287 DOI: 10.1111/ene.13335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Aseptic infections of the central nervous system (CNS) are frequently observed in Germany. However, no study has systematically addressed the spectrum of aseptic CNS infections in Germany. METHODS Data on 191 adult patients diagnosed from January 2007 to December 2014 with aseptic meningitis or encephalitis/meningoencephalitis at our hospital were collected by chart review and analyzed for demographic, clinical and laboratory findings. Patients were stratified according to the causative virus and findings were compared between groups. RESULTS In our cohort, meningitis was caused in 36% by enterovirus (EV), 15% by herpes simplex virus (HSV), 12% by varicella zoster virus (VZV) and 5% by tick borne encephalitis (TBE). Encephalitis/meningoencephalitis was caused in 13% by HSV, 13% by VZV, and three out of 11 tested patients were positive for TBE. The highest incidence of EV infections was between 25 and 35 years and of HSV infections between 30 and 60 years. VZV infections had a bimodal distribution peaking below 30 and above 70 years. VZV and EV infections were more frequently observed during summer, whereas HSV infections showed no seasonal preference. Inflammatory changes in cerebrospinal fluid (CSF) were highest in HSV and lowest in EV infections. CONCLUSIONS Polymerase chain reaction tests for HSV, VZV and EV in CSF and TBE serology determined the causative virus in over 60% of tested patients. The age of affected patients, seasonal distribution, disease course and inflammatory changes in CSF differ between groups of patients affected by the most common viral infections.
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Affiliation(s)
- M Kaminski
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - V Grummel
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - D Hoffmann
- Institute of Virology, Technische Universität/Helmholtz Zentrum München, Munich, Germany
| | - A Berthele
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Hoyer C, Eisele P, Ebert A, Schneider S, Gass A, Fatar M, Szabo K, Alonso A. Blood-CSF-barrier dysfunction is a marker for encephalitic involvement in patients with aseptic meningitis/meningoencephalitis. J Clin Virol 2016; 84:82-86. [DOI: 10.1016/j.jcv.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/28/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022]
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Parisi SG, Basso M, Del Vecchio C, Andreis S, Franchin E, Bello FD, Pagni S, Biasolo MA, Manganelli R, Barzon L, Palù G. Virological testing of cerebrospinal fluid in children aged less than 14 years with a suspected central nervous system infection: A retrospective study on 304 consecutive children from January 2012 to May 2015. Eur J Paediatr Neurol 2016; 20:588-96. [PMID: 27129875 DOI: 10.1016/j.ejpn.2016.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The study aimed to describe the prevalence of HSV DNA, VZV DNA, Enterovirus RNA, Parechovirus RNA, CMV DNA, EBV DNA, adenovirus DNA, HHV-6 DNA, HHV-7 DNA, HHV-8 DNA and Parvovirus B19DNA in children aged less 14 years with a suspected viral infection of the central nervous system in a clinical practice setting. METHODS Between January 2012 and May 2015, cerebrospinal fluids from 304 children were tested with an in-house real-time PCR method. RESULTS A positive PCR was detected in 64 subjects (21%): the mean number of tests performed in patients who showed a viral infection was 7.5, significantly higher (p = 0.001) with respect to that reported in negative samples (6.4). Enterovirus is the leading virus detected: 12 out of the 37 positive children reported were newborns (85.7% of all the newborns with a positive result). The second most frequently identified virus was HHV-7 (5 positive PCR out of 105 samples tested, 4.8%, if we excluded a child with a concomitant S. pneumoniae isolated), a prevalence significantly higher with respect to VZV (p = 0.02) and to CMV (p = 0.04). HHV-6 was the third most commonly identified aetiology (4.2%). All children were immunocompetent. SIGNIFICANCE Only a minority of children had a specific viral aetiology identified: the rate of HHV-7 positivity suggests a routine testing of these viruses within the diagnostic algorithm in immunocompetent paediatric patients. This approach could help to define the clinical role of this herpesvirus.
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Affiliation(s)
- Saverio G Parisi
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy.
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
| | - Claudia Del Vecchio
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
| | - Samantha Andreis
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
| | - Federico Dal Bello
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
| | - Silvana Pagni
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
| | - Maria Angela Biasolo
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
| | - Riccardo Manganelli
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy; Microbiology and Virology Unit, Padova University Hospital, Indirizzo: Via Giustiniani, 2, 35128 Padova, Italy
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Han SH, Choi HY, Kim JM, Park KR, Youn YC, Shin HW. Etiology of aseptic meningitis and clinical characteristics in immune-competent adults. J Med Virol 2015; 88:175-9. [DOI: 10.1002/jmv.24316] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Su-Hyun Han
- Department of Neurology, Asan Medical Center; Ulsan University College of Medicine; Seoul South Korea
| | - Hye-Yeon Choi
- Department of Neurology, Gangdong Kyung Hee University Hospital; Kyung Hee University College of Medicine; Seoul South Korea
| | - Jeong-Min Kim
- Department of Neurology; Chung-Ang University College of Medicine; Seoul South Korea
| | - Kwang-Ryul Park
- Department of Neurology; Chung-Ang University College of Medicine; Seoul South Korea
| | - Young Chul Youn
- Department of Neurology; Chung-Ang University College of Medicine; Seoul South Korea
| | - Hae-Won Shin
- Department of Neurology; Chung-Ang University College of Medicine; Seoul South Korea
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Jeon JS, Kim JK, Yu J, Kim JW. Epidemic Trends of Enterovirus Infections From Pediatric Patients in Cheonan, Korea. J Clin Lab Anal 2014; 30:161-4. [PMID: 25425450 DOI: 10.1002/jcla.21830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/29/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a single hospital during recent 5 years. This study was preformed from December 2008 to November 2013. METHODS We subjected 1,067 cerebrospinal fluid (CSF) specimens from 1,053 patients and 678 stool specimens from 665 patients using real-time reverse-transcription polymerase chain reaction tests that could detect EV. The data were analyzed according to seasonality and patient age and sex. RESULTS During this period, 176 of the total 1,053 patients (16.81%) were positive for EV in CSF. The highest rate of EV-positive samples occurred in children less than 1 year of age (114/176, 64.77%), and the most prevalent month was June. The results for CSF and stool specimens were concordant in 545 (80.38%) of 678 cases. CONCLUSION We described the epidemiological analytic data of the EV in the population of Cheonan, South Korea. The combination of the CSF and stool specimen enhances the diagnostic yield. There is a need for continuous study of EV infections and its clinical manifestations.
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Affiliation(s)
- Jae-Sik Jeon
- Department of Laboratory Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jae Kyung Kim
- Department of Laboratory Medicine, Dankook University Hospital, Cheonan, Korea
| | - Jeesuk Yu
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| | - Jong Wan Kim
- Department of Laboratory Medicine, Dankook University College of Medicine, Cheonan, Korea
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Dawood N, Desjobert E, Lumley J, Webster D, Jacobs M. Confirmed viral meningitis with normal CSF findings. BMJ Case Rep 2014; 2014:bcr-2014-203733. [PMID: 25035443 DOI: 10.1136/bcr-2014-203733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 18-year-old woman presented with a progressively worsening headache, photophobia feverishness and vomiting. Three weeks previously she had returned to the UK from a trip to Peru. At presentation, she had clinical signs of meningism. On admission, blood tests showed a mild lymphopenia, with a normal C reactive protein and white cell count. Chest X-ray and CT of the head were normal. Cerebrospinal fluid (CSF) microscopy was normal. CSF protein and glucose were in the normal range. MRI of the head and cerebral angiography were also normal. Subsequent molecular testing of CSF detected enterovirus RNA by reverse transcriptase PCR. The patient's clinical syndrome correlated with her virological diagnosis and no other cause of her symptoms was found. Her symptoms were self-limiting and improved with supportive management. This case illustrates an important example of viral central nervous system infection presenting clinically as meningitis but with normal CSF microscopy.
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Jeltema HR, Kuijlen JMA, Hoving EW. Acute hydrocephalus in a child with a third ventricle arachnoid cyst and coincidental enteroviral meningitis. Childs Nerv Syst 2014; 30:1129-33. [PMID: 24169867 DOI: 10.1007/s00381-013-2299-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/03/2013] [Indexed: 11/30/2022]
Abstract
We present a 2.5-year-old child suffering from acute hydrocephalus. First, the child was diagnosed with aseptic viral meningitis. The PCR of the cerebrospinal fluid (CSF) was positive for enterovirus. Subsequently, MRI revealed that the hydrocephalus was caused by a cyst in the third ventricle. During ventriculoscopy, the cyst had all aspects of an arachnoid cyst. An endoscopic fenestration and partial removal of the cyst was performed, combined with a ventriculocisternostomy. The coincidental finding of viral meningitis and a third ventricle arachnoid cyst in a patient with acute hydrocephalus has, to our knowledge, not been described in literature before. If there is a relation between the enteroviral meningitis, the arachnoid cyst (possibly causing a pre-existing subclinical hydrocephalus) and the rapidly evolving neurological deterioration, remains speculative. Proposed mechanisms, by which the viral meningitis could accelerate the disease process, are slight brain swelling or increased CSF production. This rare combination of diagnoses could also be coincidental.
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Affiliation(s)
- Hanne-Rinck Jeltema
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O.box 30.001, 9700 RB, Groningen, The Netherlands,
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Detection and genotyping of enteroviruses in cerebrospinal fluid in patients in Victoria, Australia, 2007-2013. J Med Virol 2014; 86:1609-13. [DOI: 10.1002/jmv.23885] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 11/07/2022]
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A vignette-based survey to assess clinical decision making regarding antibiotic use and hospitalization of patients with probable aseptic meningitis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013; 23:125-9. [PMID: 23997779 DOI: 10.1155/2012/289230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The many etiologies of meningitis influence disease severity - most viral causes are self-limiting, while bacterial etiologies require antibiotics and hospitalization. Aided by laboratory findings, the physician judges whether to admit and empirically treat the patient (presuming a bacterial cause), or to treat supportively as if it were viral. OBJECTIVE To determine factors that lead infectious disease specialists to admit and treat in cases of suspected meningitis. METHODS A clinical vignette describing a typical case of viral meningitis in the emergency department was presented to clinicians. They were asked to indicate on a Likert scale the likelihood of administering empirical antibiotics and admitting the patient from the vignette and for eight subsequent scenarios (with varied case features). The process was repeated in the context of an inpatient following initial observation and/or treatment. RESULTS Participants were unlikely to admit or to administer antibiotics in the baseline scenario, but a low Glasgow Coma Score or a high cerebrospinal fluid (CSF) white blood cell count with a high neutrophil percentage led to empirical treatment and admission. These factors were less influential after a negative bacterial CSF culture. These same clinical variables led to maintaining treatment and hospitalization of the inpatient. CONCLUSIONS Most participants chose not to admit or treat the patient in the baseline vignette. Confusion and CSF white blood cell count (and neutrophil predominance) were the main influences in determining treatment and hospitalization. A large range of response scores was likely due to differing regional practices or to different levels of experience.
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