Herpesviruses

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Herpes simplex virus The reactivation and replication of HSV leads to intype 1 (HSV-1) flammation and extensive necrosis and edema of the medial temporal lobe and orbital surface of the frontal lobe of immunocompetent patients, producing the characteristic clinical picture. Patients develop fever, headache, irritability, lethargy, confusion and focal neurological signs, such as aphasia, motor and sensory deficits, and seizures (major motor, complex partial, focal, and absence attacks). CSF examination, electroencephalography (widespread, periodic, stereotyped complexes of sharp and slow waves at regular intervals of 2-3 seconds), brain imaging, and biopsy make HSV encephalitis easy to distinguish diagnosti-cally from all other forms of viral encephalitis

Herpes simplex virus Usually, two types of neurological condition may type 2 (HSV-2) develop:

- Aseptic meningitis; about 5% of cases of aseptic meningitis in the USA are caused by genital HSV-2.The typical clinical picture of headache, fever, stiff neck, and marked CSF lymphocytic pleocytosis is often preceded by pain in the genital or pelvic region

- Encephalitis, identical to that caused by HSV-1, occurring most often in the newborn and rarely in the immunocompromised adult

Varicella zoster virus (VZV)

Cytomegalovirus (CMV)

Epstein-Barr virus (EBV)

Two neurological conditions usually develop:

- The virus causes chickenpox (varicella) in childhood, becomes latent in the dorsal root ganglia, and reactivates decades later to produce shingles (zoster) in adults. Subacute encephalitis develops against a background of cancer, immunosuppression, and AIDS, and death is common

- Granulomatous arteritis may develop, characterized by an acute focal deficit with TIA or stroke and mental symptoms. The mortality rate is 25 %

Most congenital CMV infections are asymptomatic, although many carriers develop sensorineural hearing loss and intellectual handicaps, and less often seizures, hypotonia, and spasticity. In severe meningoencephalitis, lethargy and coma occur Acquired CMV infections in immunocompromised adults, particularly AIDS patients, are very common. CMV is an important cause of encephalitis (progressive dementia, headache, focal or diffuse weakness, and seizures, attributed to CMV vasculitis or foci of demyelination), myelitis, and polyradiculitis (beginning insidiously as a cauda equina syndrome with distal weakness, paresthesias, incontinence, and sacral sensory loss)

EBV causes infectious mononucleosis, and is associated with nasopharyngeal carcinoma and Burkitt's lymphoma. EBV meningoencephalitis affects both immunocompetent and immunocompromised individuals, causing acute cerebellar ataxia, athetosis and chorea, chiasmal neuritis, or in more serious cases, meningoencephalopathy, stupor and coma. DNA of Epstein-Barr virus has been detected in CNS lymphoma tissue

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