Abstract
The cardiovascular system is regulated by a central autonomic network (CAN) consisting of the insular cortex, anterior cingulate gyrus, and amygdala. Because the insular cortex often tends to be damaged in patients with herpes simplex virus (HSV) encephalitis, the autonomic instability observed in these patients was suggested to be moderated by an insular cortex lesion. Here, we report the case of a 51-year-old Japanese male who was hospitalized following a collapse 5 days earlier; he was diagnosed as herpes encephalitis. Diffusion-weighted MRI revealed asymmetric right greater hyperintensity throughout his insular cortex and anterior cingulate gyrus. At 1 week after admission, transthoracic echo showed diffuse hypokinesis in the left ventricle (LV). Cardiac 123I-meta-iodobenzylguanidine uptake (123I-MIBG) scintigraphy revealed reduced uptake in the inferior and posterior wall. Electrocardiograhy at rest showed that the coefficient variation of RR intervals (CVR-R) was reduced, and the corrected QT (QTc) interval length was prolonged. In this HSV encephalitis patient, signs of a right insular cortex lesion and autonomic instability were observed: LV hypokinesis, regional reduced 123I-MIBG uptake, decreased CVR-R, and QTc interval prolongation. Our patient’s autonomic instability may thus be derived from disrupted autonomic balance due to the right insular cortex lesion.
Similar content being viewed by others
References
Beissner F, Meissner K, Bär KJ, Napadow V (2013) The autonomic brain: an activation likelihood estimation meta-analysis for central processing of autonomic function. J Neurosci 33:10503–10511
Braune S, Reinhardt M, Schnitzer R, Riedel A, Lücking CH (1999) Cardiac uptake of [123I] MIBG separates Parkinson’s disease from multiple system atrophy. Neurology 53:1020–1025
Gooch R (2009) Ictal asystole secondary to suspected herpes simplex encephalitis: a case report. Cases J 2:9378
Harada T, Abe J, Shiotani M, Hamada Y, Horii I (2005) Effect of autonomic nervous function on QT interval in dogs. J Toxicol Sci 30:229–237
Hilz MJ, Dutsch M, Perrine K, Nelson PK, Rauhut U, Devinsky O (2001) Hemisphreic influence on autonomic modulation and baroreflex sensitivity. Ann Neurol 49:575–584
Nagai M, Hoshide S, Kario K (2010) The insular cortex and cardiovascular system: a new insight into the brain-heart axis. J Am Soc Hypertens 4:174–182
Nagai M, Dote K, Kato M, Sasaki S, Oda N, Kagawa E, Nakano Y, Yamane A, Higashihara T, Miyauchi S, Tsuchiya A, Harada W, Kario K (2017) The insular cortex and Takotsubo cardiomyopathy. Curr Pharm Des 23:879–888
Oyanguren B, Sánchez V, González FJ, de Felipe A, Esteban L, López-Sendón JL, Garcia-Barragán N, Martínez-San Millán J, Masjuán J, Corral I (2013) Limbic encephalitis: a clinical-radiological comparison between herpetic and autoimmune etiologies. Eur J Neurol 20:1566–1570
Smith BK, Cook MJ, Prior DL (2008) Sinus node arrest secondary to HSV encephalitis. J Clin Neurosci 15:1053–1056
Vogt BA, Finch DM, Olson CR (1992) Functional heterogeneity in cingulate cortex: the anterior executive and posterior evaluative regions. Cereb Cortex 2:435–443
Wieland DM, Brown LE, Rogers WL, Worthington KC, Wu JL, Clinthorne NH, Otto CA, Swanson DP, Beierwaltes WH (1981) Myocardial imaging with a radioiodinated norepinephrine storage analog. J Nucl Med 22:22–31
Yoshita M (1998) Differentiation of idiopathic Parkinson’s disease from striatonigral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. J Neurol Sci 155:60–67
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Kikumoto, M., Nagai, M., Ohshita, T. et al. Insular cortex lesion and autonomic instability in a herpes simplex virus encephalitis patient. J. Neurovirol. 24, 649–651 (2018). https://doi.org/10.1007/s13365-018-0652-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13365-018-0652-2