A successfully treated case of herpes simplex encephalitis complicated by subarachnoid bleeding: a case report

<p>Abstract</p> <p>Introduction</p> <p>Histopathologically, herpes simplex virus type 1 causes hemorrhagic necrosis. Overt hemorrhage is infrequent in herpes simplex virus encephalitis but can lead to poor outcomes. This report describes a successfully treated case of herpes simplex virus encephalitis associated with subarachnoid bleeding in which real-time polymerase chain reaction was useful for diagnosis.</p> <p>Case presentation</p> <p>A 30-year-old previously healthy Japanese woman who had fever and headache for five days presented with disorganised speech, unusual behavior and delusional thinking. Real-time polymerase chain reaction amplification of herpes simplex virus type 1 in cerebrospinal fluid was positive (38,000 copies/mL) and antivirus treatment was started. During the course of her illness, the level of her consciousness decreased in association with desaturation and tachycardia. Thrombosis of the right pulmonary artery trunk with pulmonary embolism was evident on enhanced chest computed tomography. In addition, cranial computed tomography revealed subarachnoid and intraventricular bleeding. Intravenous heparin (12,000 U/day) was started and the dose was adjusted according to the activated partial thromboplastin time for about a month (maximum dose of heparin, 20,400 U/day). After the treatments, her Glasgow coma score increased and the thrombosis of the pulmonary artery trunk had disappeared.</p> <p>Conclusions</p> <p>The present case raises the question of whether anticoagulant treatment is safe in patients with herpes simplex virus encephalitis complicated by subarachnoid bleeding.</p

Asymmetrical Weakness Associated with Central Nervous System Involvement in a Patient with Guillain-Barrè Syndrome

Guillain-Barrè syndrome (GBS) is usually associated with symmetrical weakness, and therefore asymmetrical weakness may confuse diagnosis. We report on a patient with GBS subsequent to Campylobacter jejuni enteritis who had asymmetrical weakness with CNS involvement. The patient tested positive for anti-ganglioside antibodies, including anti-GM1 IgM, anti-GD1b IgG, and anti-GT1a IgG. Patients with GBS can manifest asymmetrical signs and symptoms attributable to CNS involvement. Prompt, accurate diagnosis and treatment of post- C. jejuni GBS is especially important because its prognosis is relatively poor

Characteristic MRI Findings of upper Limb Muscle Involvement in Myotonic Dystrophy Type 1.

The objective of our study was to evaluate the relation between muscle MRI findings and upper limb weakness with grip myotonia in patients with myotonic dystrophy type 1 (DM1). Seventeen patients with DM1 were evaluated by manual muscle strength testing and muscle MRI of the upper limbs. Many DM1 patients presenting with decreased grasping power frequently showed high intensity signals in the flexor digitorum profundus (FDP) muscles on T1-weighted imaging. Patients presenting with upper limb weakness frequently also showed high intensity signals in the flexor pollicis longus, abductor pollicis longus, and extensor pollicis muscles. Disturbances of the distal muscles of the upper limbs were predominant in all DM1 patients. Some DM1 patients with a prolonged disease duration showed involvement of not only distal muscles but also proximal muscles in the upper limbs. Muscle involvement of the upper limbs on MRI strongly correlated positively with the disease duration or the numbers of CTG repeats. To our knowledge, this is the first study to provide a detailed description of the distribution and severity of affected muscles of the upper limbs on MRI in patients with DM1. We conclude that muscle MRI findings are very useful for identifying affected muscles and predicting the risk of muscle weakness in the upper limbs of DM1 patients

Muscle MRI findings of the upper limb muscles in myotonic dystrophy type 1.

<p>Typical findings of muscle MRI in a patient with mild disease, patient 4 (A, B), and a patient with severe disease, patient 7 (C, D), as summarized in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0125051#pone.0125051.t001" target="_blank">Table 1</a>. On T1-weighted images, only the FDP muscle showed high intensity signals with fatty degeneration in patient 4. In patient 7, the FDP muscle as well as a few other muscles showed high intensity signals with fatty degeneration. A, C = arm muscles; B, D = forearm muscles.</p

Distribution of affected muscles detected by muscle MRI.

<p>BB = biceps brachii; TB = triceps brachii; B = brachialis; BR = brachioradialis; FCU = flexor carpi ulnaris; FCR = flexor carpi radialis; FDP = flexor digitorum profundus; FDS = flexor digitorum superficialis, FPL = flexor pollicis longus; APL = abductor pollicis longus; EP = extensor pollicis longus and brevis; ECU = extensor carpi ulnaris; ECR = extensor carpi radialis; EDC = extensor digitorum communis; P = pronator teres; S = supinator.</p><p>- = normal; + mild change; ++ = mild to moderate change; +++ = moderate change; ++++ = severe change.</p><p>Distribution of affected muscles detected by muscle MRI.</p

Frequency of muscles in the upper limbs showing >30% fat infiltration.

<p>BB = biceps brachii; TB = triceps brachii; B = brachialis; BR = brachioradialis; FCU = flexor carpi ulnaris; FCR = flexor carpi radialis; FDP = flexor digitorum profundus; FDS = flexor digitorum superficialis, FPL = flexor pollicis longus; APL = abductor pollicis longus; EP = extensor pollicis longus and brevis; ECU = extensor carpi ulnaris; ECR = extensor carpi radialis; EDC = extensor digitorum communis; P = pronator teres; S = supinator.</p

Clinical characteristics of 17 patients with myotonic dystrophy type 1.

<p>Clinical characteristics of 17 patients with myotonic dystrophy type 1.</p