INTRODUCTION: Morbidity and mortality of Herpes simplex virus encephalitis (HSE) remain high. Relapses of neurological signs may occur after initial clinical improvement under acyclovir treatment. METHODS: We report here a case of post-HSE anti-N-methyl-d-aspartate receptor-mediated encephalitis in an adult and perform a systematic search on PubMed to identify other cases in adults. RESULTS: We identified 11 previously published cases, to discuss diagnostic and therapeutic management. Symptoms in adults are often inappropriate behaviors, confusion and agitation. Diagnosis of anti-NMDA-R encephalitis after HSE is often delayed. Treatment consists in steroids, plasma exchange, and rituximab. Prognosis is often favorable. CONCLUSION: Anti-NMDA-R antibodies should be searched in cerebrospinal fluid of patients with unexpected evolution of HSE. This emerging entity reopens the hot debate about steroids in HSE.
INTRODUCTION: Morbidity and mortality of Herpes simplex virus encephalitis (HSE) remain high. Relapses of neurological signs may occur after initial clinical improvement under acyclovir treatment. METHODS: We report here a case of post-HSE anti-N-methyl-d-aspartate receptor-mediated encephalitis in an adult and perform a systematic search on PubMed to identify other cases in adults. RESULTS: We identified 11 previously published cases, to discuss diagnostic and therapeutic management. Symptoms in adults are often inappropriate behaviors, confusion and agitation. Diagnosis of anti-NMDA-R encephalitis after HSE is often delayed. Treatment consists in steroids, plasma exchange, and rituximab. Prognosis is often favorable. CONCLUSION: Anti-NMDA-R antibodies should be searched in cerebrospinal fluid of patients with unexpected evolution of HSE. This emerging entity reopens the hot debate about steroids in HSE.
Authors: Thaís Armangue; Germán Moris; Verónica Cantarín-Extremera; Carlos Enrique Conde; Kevin Rostasy; Maria Elena Erro; Juan Carlos Portilla-Cuenca; Eulàlia Turón-Viñas; Ignacio Málaga; Beatriz Muñoz-Cabello; Carmen Torres-Torres; Sara Llufriu; Luis González-Gutiérrez-Solana; Guillermo González; Ignacio Casado-Naranjo; Myrna Rosenfeld; Francesc Graus; Josep Dalmau Journal: Neurology Date: 2015-10-21 Impact factor: 9.910
Authors: Judith N Wagner; Gabriele Schwarz; Gertraud Puttinger; Anna Maria Hengsberger; Stefan Guggenberger; Serge Weis; Johannes Trenkler; Martin Aichholzer; Tim J von Oertzen Journal: J Neurol Date: 2018-05-30 Impact factor: 4.849