Abstract Details

Title Herpes-Simplex Virus 2: A New Player in Cerebral Vasculitis

Topic Infections/AIDS/Prion Disease

Presentation(s) P03 - (-)

Poster/Presentation
Number 259

Objective

Background BACKGROUND: HSV-2 causes a wide range of pathologies in the human central nervous system (CNS) including meningitis, myelitis, and encephalitis. Cerebral vasculitis related to HSV-2 has not been reported so far.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 72-year-old immunocompetent man was referred with acute onset of nonfluent aphasia and right-sided weakness. The CT scan revealed a 4x1.8 cm left thalamic hemorrhage. Two days later, his clinical condition started to deteriorate with development of somnolence and fever up to 103.3[deg]F on the next day. Transcranial sonography velocities of the middle cerebral arteries (MCA) increased to up to 220 cm/s (right) and 170 cm/s (left). Diffusion-weighted imaging (DWI) demonstrated ischemic lesions within territories supplied by the left MCA and the right posterior inferior cerebellar artery. Time-of-flight angiography determined irregular narrowing over short segments in various large to medium-sized cerebral arteries. A CSF pleocytosis of 588 cells/L with elevated protein (1.75 g/L) indicated intrathecal inflammation. CSF-PCR for HSV-2 was positive with high copy numbers (9,650 genomic equivalents/mL), whereas PCR examination for HSV-1, VZV, CMV was negative. Evidence for a direct involvement of HSV-2 was derived from rapid improvement of both the patient's condition and the increased flow velocities of intracranial vessels after initiation of IV acyclovir therapy.

Conclusions CONCLUSIONS: The spectrum of atypical CNS manifestations related to HSV is emerging. We report a case of cerebral vasculitis, which was masked by the initial presentation as thalamic hemorrhage and followed by an encephalitic syndrome and multifocal ischemic stroke. The work-up revealed HSV-2 as a new and treatable cause of infectious vasculitis.

Authors/Disclosures
Johann Sellner, MD, FAAN (Neurologie, LK Mistelbach) PRESENTER	Dr. Sellner has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Boehringer, Celgene, Immunic, Merck, Novartis, Roche, Sanofi. Dr. Sellner has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion, Biogen, Immunic, Merck, Novartis, Roche, Sanofi. Dr. Sellner has received personal compensation in the range of $0-$499 for serving as a Reviewer with Ethics Committtee.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Bernhard Hemmer, MD (Technische Universität München)	No disclosure on file
	No disclosure on file
	No disclosure on file

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