中枢神経感染症を疑うときのアプローチ

単純ヘルペス脳炎患者の頭部MRI（T2強調画像）

左側頭葉・前頭葉・頭頂葉に及ぶ高信号域の病変がT2強調画像にて認められる。
出典
imgimg
1: Relationship of herpes simplex encephalitis and transcranial direct current stimulation--a case report.
著者: Yuanbin Yang, Juan Xiao, Haiqing Song, Ralph Wang, Mohammed Hussain, Weiqun Song
雑誌名: J Clin Virol. 2015 Apr;65:46-9. doi: 10.1016/j.jcv.2015.01.012. Epub 2015 Jan 17.
Abstract/Text: We report a rare case of relapsing herpes simplex encephalitis in a-37-year-old patient which was previously confirmed by positive polymerase chain reaction, herpes simplex virus (HSV) type1 IgG antibodies in cerebrospinal fluid and characterized on MRI. During the first admission, he was treated with continuous acyclovir treatment for one month with clinical improvement except for residual aphasia, for which he received a course of outpatient transcranial direct current stimulation (tDCS). A constant current of 1.2 mA was applied for 20 min twice daily. After the 4th day the patient was found to be irritable and uncooperative by staff and family members. A subsequent MRI showed significant deterioration of the lesion on comparison to the first MRI which led to discontinuation of tDCS.The relatively rapid exacerbation of HSV in only a few days is unusual. Our aim is to discuss if tDCS is related to HSV relapse and in doing so highlight possible mechanisms.

Copyright © 2015. Published by Elsevier B.V.
J Clin Virol. 2015 Apr;65:46-9. doi: 10.1016/j.jcv.2015.01.012. Epub 2...

単純ヘルペス脳炎患者の頭部MRI（T1強調画像・FLAIR・拡散強調画像）

両側の島皮質・左前頭葉・左側頭葉・左頭頂葉に及ぶ病変がT1強調画像（a）、FLAIR（b）、拡散強調画像（c）で認められる。
出典
imgimg
1: Diffusion imaging in brain infections.
著者: Emerson L Gasparetto, Rafael F Cabral, L Celso Hygino da Cruz, Romeu C Domingues
雑誌名: Neuroimaging Clin N Am. 2011 Feb;21(1):89-113, viii. doi: 10.1016/j.nic.2011.01.011.
Abstract/Text: Diffusion-weighted magnetic resonance imaging (DWI) provides image contrasts that are different from conventional magnetic resonance techniques. DWI is particularly sensitive for detecting acute ischemic stroke, but it also has many other clinical applications, including the evaluation of central nervous system (CNS) infections. This article addresses the role of DWI in the differential diagnosis of CNS infections, and discusses the most common DWI findings for each type of infection.

Copyright © 2011. Published by Elsevier Inc.
Neuroimaging Clin N Am. 2011 Feb;21(1):89-113, viii. doi: 10.1016/j.ni...

中枢神経感染症を疑うときのアプローチ

単純ヘルペス脳炎患者の頭部MRI（T2強調画像）

左側頭葉・前頭葉・頭頂葉に及ぶ高信号域の病変がT2強調画像にて認められる。
出典
imgimg
1: Relationship of herpes simplex encephalitis and transcranial direct current stimulation--a case report.
著者: Yuanbin Yang, Juan Xiao, Haiqing Song, Ralph Wang, Mohammed Hussain, Weiqun Song
雑誌名: J Clin Virol. 2015 Apr;65:46-9. doi: 10.1016/j.jcv.2015.01.012. Epub 2015 Jan 17.
Abstract/Text: We report a rare case of relapsing herpes simplex encephalitis in a-37-year-old patient which was previously confirmed by positive polymerase chain reaction, herpes simplex virus (HSV) type1 IgG antibodies in cerebrospinal fluid and characterized on MRI. During the first admission, he was treated with continuous acyclovir treatment for one month with clinical improvement except for residual aphasia, for which he received a course of outpatient transcranial direct current stimulation (tDCS). A constant current of 1.2 mA was applied for 20 min twice daily. After the 4th day the patient was found to be irritable and uncooperative by staff and family members. A subsequent MRI showed significant deterioration of the lesion on comparison to the first MRI which led to discontinuation of tDCS.The relatively rapid exacerbation of HSV in only a few days is unusual. Our aim is to discuss if tDCS is related to HSV relapse and in doing so highlight possible mechanisms.

Copyright © 2015. Published by Elsevier B.V.
J Clin Virol. 2015 Apr;65:46-9. doi: 10.1016/j.jcv.2015.01.012. Epub 2...