대상포진 수막뇌염의 역학 및 임상 양상

김종규 ( Jong Kyu Kim ),이예선 ( Yea Son Lee ),나찬호 ( Chan Ho Na ),김민성 ( Min Sung Kim ),신봉석 ( Bong Seok Shin ) 대한피부과학회 2016 大韓皮膚科學會誌 Vol.54 No.10

Background: Many studies about herpes zoster are available in Korean dermatological literature. However, only a few of them reported herpes zoster meningoencephalitis. Objective: The aim of this study was to determine the epidemiology and clinical features of herpes-zoster meningoencephalitis compared with herpes zoster without meningoencephalitis. Methods: We examined the medical records of 3,154 patients with herpes zoster, who had visited our hospital from January 2008 to March 2016. Among them, 159 patients underwent cerebrospinal fluid analysis. Fifty-one patients who were diagnosed with herpes zoster meningoencephalitis and the 3,103 patients who were without meningoencephalitis were subjected to examinations to assess the incidence rates, the age distribution, the ganglion distribution, severity of acute pain, postherpetic neuralgia, serum VZV IgM and IgG, the clinical aspects, the underlying diseases, and the presence of complications. Results: The rate of herpes zoster meningoencephalitis was 1.61%, with a mean age of 53.95 years, and the female-to-male patient ratio was 1.68. The trigeminal nerve was the most frequently involved dermatome (53.7%), with the ophthalmic branch (V1) involved at a rate of 68.96% among them. The serum VZV IgM was significantly higher in herpes zoster meningoencephalitis compared with herpes zoster without meningoencephalitis. Dizziness, mental change, palsy, and myalgia with nausea/vomiting showed high predictive values. All the patients were treated with acyclovir for 10∼14 days, and 1 of them expired (1.96%). Conclusion: The results of this study demonstrated that herpes-zoster meningoencephalitis was associated with high serum levels of VZV IgM compared with herpes zoster without meningoencephalitis. When a patient with herpes zoster has symptoms of headache and nausea/vomiting with dizziness, mental status change, palsy, or myalgia, herpes-zoster meningoencephalitis should be considered. (Korean J Dermatol 2016;54(10):788∼795)

대상포진 수막뇌염의 임상적 고찰

변지원 ( Ji Won Byun ),송희진 ( Hee Jin Song ),최광성 ( Gwang Seong Choi ),신정현 ( Jeong Hyun Shin ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.4

Background: Herpes zoster meningoencephalitis is a rare neurological complication and the known risk factors include an immunocompromised status, infiltration into the trigeminal ganglion, disseminated herpes zoster and elderly patients. Serious complications may develop, including cerebral hemorrhage. Objective: As early diagnostic detection is mandatory to prevent long-term sequelae, we wanted to determine what signs and symptoms we should focus on for diagnosing zoster meningoencephalitis at an early stage. We also investigated the descriptive statistics of the patients and compared them with the patients who had non-complicated herpes zoster. Methods: We examined the medical records of 5114 herpes zoster patients who had visited our clinic from 1996 through 2009. Among them, 18 patients who were diagnosed with herpes zoster meningoencephalitis by cerebrospinal fluid tests were subject to examinations to assess the incidence rates, the age distribution, the ganglion distribution, the clinical aspects, the underlying diseases and the presence of complications. Results: The ages of the patients with herpes zoster meningoencephalitis showed that 50% of the patients were under 30 years old. Infiltration into the trigeminal ganglion and immunocompromising underlying diseases accounted for 50% and 16.7% of the total patients, respectively. In the case of disseminated herpes zoster patients, no meningoencephalitis developed. The rates of neck stiffness and fever, which are the most common symptoms of meningoencephalitis, were lower in the patients with herpes zoster meningoencephalitis (33.3% and 11.1%, respectively). However, headaches accompanied with nausea or vomiting showed high sensitivity (88.9%), and a high positive predictive value (69.6%) (p<0.001). All the patients were treated with acyclovir for 10∼14 days, and cerebral hemorrhage occurred in 1 of them (5.5%) after treatment. Conclusion: When a patient with herpes zoster has symptoms of headache and nausea or vomiting then herpes zoster meningoencephalitis should be considered even if neck stiffness and fever are not present. (Korean J Dermatol 2011;49(4):328∼333)

[P279] A case of meningoencephalitis due to sacral herpes zoster

( Jong Baik Kim ),( Suk Young Lee ),( Hoo Min Choi ),( Sung Min Kim ),( Eun Jung Ko ),( Byung In Ro ),( Han Kyoung Cho ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Meningoencephalitis is a condition which the membranesof brain and spinal cord are in an inflammatory or infective state. Altered consciousness, fever, headache and neck stiffness are the most common symptoms and if it is not treated properly, life threatening events might occur. Meningoencephalitis is caused by bacteria, viruses and other microorganisms. There are reports of herpes zoster induced meningoencephalitis, composing 0.2% of herpes zoster neurologic complications. A 60 year old woman was hospitalized in the dermatology department due to herpes zoster on her right second sacral dermatome. During the third day of admission, the patient lost her orientation along with severe headache and was transferred to the neurologic department for further analysis. CSF analysis and brain MRI results indicated herpes zoster induced meningoencephalitis. Patient was treated with long term high dose antiviral and recovered her health. Interestingly, in this case, meningoencephalitis was induced by sacral herpes zoster, a quite remote area from the brain.

Ramsay Hunt Syndrome Complicated by Meningoencephalitis and Radiologic findings: a Rare Case Report

Lee, Youdae,Lee, Donghoon Korean Society of Magnetic Resonance in Medicine 2019 Investigative Magnetic Resonance Imaging Vol.23 No.1

Ramsay Hunt syndrome with the complication of encephalitis or meningoencephalitis is rarely reported and uncommon in immunocompetent patients. The radiological manifestations of such cases usually involve the cerebellum and brainstem or exhibit the absence of any abnormality. We report a case of a 78-year-old immunocompetent man hospitalized with Ramsay Hunt syndrome, who later developed meningoencephalitis. The cerebrospinal fluid-study excluded other causes of meningoencephalitis, and the clinical diagnosis indicated varicella zoster virus meningoencephalitis. Magnetic resonance imaging revealed increased signal intensities in the bilateral temporal lobe, midbrain, and pons on T2-weighted imaging, and T2 fluid attenuated inversion recovery and contralateral asymmetric pachymeningeal enhancement. Contrast-enhanced T1-weighted imaging revealed ipsilateral facial nerve enhancement.

Ramsay Hunt Syndrome Complicated by Meningoencephalitis and Radiologic findings: a Rare Case Report

이유대,이동훈 대한자기공명의과학회 2019 Investigative Magnetic Resonance Imaging Vol.23 No.1

Ramsay Hunt syndrome with the complication of encephalitis or meningoencephalitis is rarely reported and uncommon in immunocompetent patients. The radiological manifestations of such cases usually involve the cerebellum and brainstem or exhibit the absence of any abnormality. We report a case of a 78-year-old immunocompetent man hospitalized with Ramsay Hunt syndrome, who later developed meningoencephalitis. The cerebrospinal fluid-study excluded other causes of meningoencephalitis, and the clinical diagnosis indicated varicella zoster virus meningoencephalitis. Magnetic resonance imaging revealed increased signal intensities in the bilateral temporal lobe, midbrain, and pons on T2-weighted imaging, and T2 fluid attenuated inversion recovery and contralateral asymmetric pachymeningeal enhancement. Contrast-enhanced T1-weighted imaging revealed ipsilateral facial nerve enhancement.

Comment on “Parainfectious Anti-Glial Fibrillary Acidic Protein-Associated Meningoencephalitis”

안병준,권겸일 대한파킨슨병및이상운동질환학회 2022 Journal Of Movement Disorders Vol.15 No.2

Autoimmune-mediated meningoencephalitis has been noted and actively studied in recent years. The clinical spectrum of anti-GFAP-mediated autoimmune disorders encompasses meningoencephalitis, myelitis, movement disorders, epilepsy, and cerebellar ataxia

모락셀라수막뇌염: 증례와 문헌고찰

최한나,김동욱,윤동주,고영채,장상현,윤수진,오건세,이수주 대한신경과학회 2012 대한신경과학회지 Vol.30 No.3

Moraxella is an aerobic, Gram-negative coccobacillus, which is rarely associated with serious and invasive infections. Because of its rarity, the clinical significance and appropriate therapy for infections due to Moraxella are not well understood. We report a case of meningoencephalitis caused by Moraxella. The patient presented with fever and confusion and was successfully treated with beta-lactam and aminoglycoside antibiotics. We also review 8 previously published cases of Moraxella meningitis or meningoencephalitis.

정상 면역 성인에서 발생한 Parvovirus B19에 의한 수막뇌염

이대승,이진형,허소영,김민정,김명국,유봉구 고신대학교(의대) 고신대학교 의과대학 학술지 2015 고신대학교 의과대학 학술지 Vol.30 No.2

Parvovirus B19 (PVB19) infection is a rare cause of meningoencephalitis. A 53-year-old previously healthy woman presented with fever, headache, and multiple erythema on the both legs. Cerebrospinal fluid study revealed pleocytosis and elevated opening pressure and protein level. Brain MRI showed multiple, asymmetric, hyperintensity in the brain stem, basal ganglia, white matter, and gray matter. Anti-B19 IgM antibody and PCR for PVB19 were positive in serum. Clinician should consider PVB19 infection in any case of acute febrile illness with erythema and meningoencephalitis

Detection of Listeria monocytogenes in CSF from Three Patients with Meningoencephalitis by Next-Generation Sequencing

Ming Yao,Jiali Zhou,Yicheng Zhu,Yinxin Zhang,Xia Lv,Ruixue Sun,Ao Shen,Haitao Ren,Liying Cui,Hongzhi Guan,Honglong Wu 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.4

Background and Purpose Encephalitis caused by Listeria monocytogenes (L. monocyto¬genes) is rare but sometimes fatal. Early diagnosis is difficult using routine cerebrospinal flu¬id (CSF) tests, while next-generation sequencing (NGS) is increasingly being used for the detection and characterization of pathogens. Methods This study set up and applied unbiased NGS to detect L. monocytogenes in CSF collected from three cases of clinically suspected listeria meningoencephalitis. Results Three cases of patients with acute/subacute meningoencephalitis are reported. Magnetic resonance imaging and blood cultures led to a suspected diagnosis of L. monocy¬togenes, while the CSF cultures were negative. Unbiased NGS of CSF identified and se¬quenced reads corresponding to L. monocytogenes in all three cases. Conclusions This is the first report highlighting the feasibility of applying NGS of CSF as a diagnostic method for central nervous system (CNS) L. monocytogenes infection. Routine application of this technology in clinical microbiology will significantly improve diagnostic methods for CNS infectious diseases.

Orthostatic hypotension with meningoencephalitis involving the rostral ventrolateral medulla

Young Ik-Jung,Mun Kyung Sunwoo,Hee Jin Lee,Jeong Hee Seo,김정연 대한임상신경생리학회 2019 Annals of Clinical Neurophysiology Vol.21 No.1

Orthostatic hypotension (OH) is commonly associated with autonomic failure in the peripheral nervous system. Less often it is related to central lesions in brainstem and cerebellum. We describe a patient with OH associated with tuberculosis meningoencephalitis involving the brainstem including rostral ventrolateral medulla. This is the first case of OH resulting from focal lesions in the dorsal medulla in a patient with meningoencephalitis.