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Subcortical type cognitive impairment in herpes zoster encephalitis

Abstract

Nine immunocompetent patients with acute herpes zoster encephalitis (HZE) were studied with the help of neurological, neuroradiological and neuropsychological investigations. All patients were treated with acyclovir. Neuropsychological performance was compared with that of a group of 16 healthy controls. Computed tomography of the head showed infarct-like hypodense lesions in two patients, involving the internal capsule in one case and the temporoparietal cortex and white matter in another. Hypoperfusion shown by single photon emission computed tomography, mostly involving the frontal areas bilaterally, was seen in six of the seven patients examined. Hyperperfusion as seen in herpes simplex encephalitis was not encountered. One patient remained mildly demented, but all the other patients recovered relatively well. Neuropsychological examination after acyclovir treatment showed a decline in memory and speed of cognitive processes, without circumscribed neuropsychological deficits. Six of the nine patients showed behavioural disinhibition, and mood changes were also observed. Memory impairment in HZE was not as global or as severe as is described after encephalitis due to herpes simplex virus. In HZE both the brain perfusion pattern and the neuropsychological test profile showed features compatible with subcortical dysfunction.

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References

  1. Albert ML, Feldman RG, Willis AL (1974) The ‘subcortical dementia’ of progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 37:121–130

    CAS  Article  Google Scholar 

  2. Andiman WA, White Greenwald M, Tinghitella T (1982) Zoster encephalitis. Isolation of virus and measurement of varicella-zoster-specific antibodies in cerebrospinal fluid. Am J Med 73:769–772

    CAS  Article  Google Scholar 

  3. Appelbaum E, Kreps SI, Sunshine A (1962) Herpes zoster encephalitis. Am J Med 32:25–31

    CAS  Article  Google Scholar 

  4. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:53–63

    Article  Google Scholar 

  5. Benton A (1974) The Revised Visual Retention Test. The Psychological Corporation, New York

    Google Scholar 

  6. Benton AL (1968) Differential behavioral effects in frontal lobe disease. Neuropsychologia 6:53–60

    Article  Google Scholar 

  7. Brown RG, Marsden CD (1988) ‘Subcortical dementia’: the neuropsychological evidence. Neuroscience 25:363–387

    CAS  Article  Google Scholar 

  8. Christensen AL (1975) Luria’s neuropsychological investigation. Text. Munksgaard, Copenhagen

    Google Scholar 

  9. Cummings JL, Benson DF (1984) Subcortical dementia. Review of an emerging concept. Arch Neurol 41:874–879

    CAS  Article  Google Scholar 

  10. Damasio AR, Van Hoesen GW (1985) The limbic system and the localization of herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 48:297–301

    CAS  Article  Google Scholar 

  11. D’Antona R, Baron JC, Samson Y, Serdaru M, Viader F, Agid Y, Cambier J (1985) Subcortical dementia. Frontal cortex hypometabolism detected by positron tomography in patients with progressive supranuclear palsy. Brain 108:785–799

    Article  Google Scholar 

  12. Davis LE, Johnson RT (1979) An explanation for the localization of herpes simplex encephalitis? Ann Neurol 5:2–5

    CAS  Article  Google Scholar 

  13. Gjerstad L, Nyberg Hansen R, Bjorland O, Nakstad P, Russell D, Rootwelt K (1986) Herpes zoster ophthalmicus with cerebral angiitis and reduced cerebral blood flow. Acta Neurol Scand 74:460–466

    CAS  Article  Google Scholar 

  14. Goffinet AM, De Voider AG, Gillain C, Rectem D, Bol A, Michel C, Cogneau M, Labar D, Laterre C (1989) Positron tomography demonstrates frontal lobe hypometabolism in progressive supranuclear palsy. Ann Neurol 25:131–139

    CAS  Article  Google Scholar 

  15. Golden CJ (1978) Stroop Color and Word Test. A manual for clinical and experimental uses. Stoelting Company, Chicago

    Google Scholar 

  16. Gordon B, Seines OA, Hart JJ, Hanley DF, Whitley RJ (1990) Long-term cognitive sequelae of acyclovir-treated herpes simplex encephalitis. Arch Neurol 47:646–647

    CAS  Article  Google Scholar 

  17. Guess HA, Broughton DD, Melton LJ, Kurland LT (1986) Population-based studies of varicella complications. Pediatrics 78:723–727

    CAS  PubMed  Google Scholar 

  18. Hall P (1963) Korsakov’s syndrome following herpes-zoster encephalitis. Lancet 1:752

    CAS  Article  Google Scholar 

  19. Hierons R, Janota I, Corsellis JA(1978) The late effects of necrotizing encephalitis of the temporal lobes and limbic areas: a clinico-pathological study of 10 cases. Psychol Med 8:21–42

    CAS  Article  Google Scholar 

  20. Ho DD, Hirsch MS (1985) Acute viral encephalitis. Med Clin North Am 69: 415–429

    CAS  Article  Google Scholar 

  21. Horten B, Price RW, Jimenez D (1981) Multifocal varicella-zoster virus leukoencephalitis temporally remote from herpes zoster. Ann Neurol 9:251–266

    CAS  Article  Google Scholar 

  22. Hughes BA, Kimmel DW, Aksamit AJ (1993) Herpes zoster-associated meningoencephalitis in patients with systemic cancer. Mayo Clin Proc 68: 652–655

    CAS  Article  Google Scholar 

  23. Jemsek J, Greenberg SB, Taber L, Harvey D, Gershon A, Couch RB (1983) Herpes zoster-associated encephalitis: clinicopathologic report of 12 cases and review of the literature. Medicine 62:81–97

    CAS  Article  Google Scholar 

  24. Johns DR, Gress DR (1987) Rapid response to acyclovir in herpes zoster-associated encephalitis. Am J Med 82:560–562

    CAS  Article  Google Scholar 

  25. Kapur N, Barker S, Burrows EH, Ellison D, Brice J, Illis LS, Scholey K, Colbourn C, Wilson B, Loates M (1994) Herpes simplex encephalitis: long term magnetic resonance imaging and neuropsychological profile. J Neurol Neurosurg Psychiatry 57:1334–1342

    CAS  Article  Google Scholar 

  26. Kendall PC, Hollon SD, Beck AT, Hammen CL, Ingram RE(1987) Issues and recommendations regarding use of the Beck Depression Inventory. Cogn Ther Res 11:289–299

    Article  Google Scholar 

  27. Launes J, Nikkinen P, Lindroth L, Brownell AL, Liewendahl K, Iivanainen M (1988) Diagnosis of acute herpes simplex encephalitis by brain perfusion single photon emission computed tomography. Lancet 1:1188–1191

    CAS  Article  Google Scholar 

  28. Launes J, Hokkanen L, Nikkinen P, Liewendahl K, Salonen O, Sirén J, Iivanainen M (1995) Hypofixation of 99mTc-HMPAO and hypofixation of 1231-iomazenil in acute herpes encephalitis. Neuroreport 6:1203–1206

    CAS  Article  Google Scholar 

  29. Leng NR, Parkin AJ (1988) Double dissociation of frontal dysfunction in organic amnesia. Br J Clin Psychol 27:359–362

    Article  Google Scholar 

  30. Lentz D, Jordan JE, Pike GB, Enzmann DR (1993) MRI in varicellazoster virus leukoencephalitis in the immunocompromised host. J Comput Assist Tomogr 17:313–316

    CAS  Article  Google Scholar 

  31. Lezak MD (1983) Neuropsychological assessment. Oxford University Press, New York, pp 152–180

    Google Scholar 

  32. Luria AR (1970) Traumatic aphasia. Its syndromes, psychology and treatment. Mouton, The Hague, pp 314–322

    Book  Google Scholar 

  33. Luria AR (1980) Higher cortical function in man. Basic Books, New York

    Book  Google Scholar 

  34. Mazur MH, Dolin R (1978) Herpes zoster at the NIH: a 20 year experience. Am J Med 65:738–744

    CAS  Article  Google Scholar 

  35. McCormick WF, Rodnitzky RL, Schochet SS Jr, McKee AP (1969) Varicella-zoster encephalomyelitis. A morphologic and virologie study. Arch Neurol 21:559–570

    CAS  Article  Google Scholar 

  36. McKenna KF, Warneke LB (1992) Encephalitis associated with herpeszoster: a case report and review. Can J Psychiatry 37:271–273

    CAS  Article  Google Scholar 

  37. Nauta WJ (1971) The problem of the frontal lobe: a reinterpretation. J Psychiatr Res 8:167–187

    CAS  Article  Google Scholar 

  38. Noms FH Jr, Leonards R, Calanchini PR, Calder CD (1970) Herpes-zoster meningoencephalitis. J Infect Dis 122:335–338

    Article  Google Scholar 

  39. Peatfield RC (1987) Basal ganglia damage and subcortical dementia after possible insidious Coxsackie virus encephalitis. Acta Neurol Scand 76:340–345

    CAS  Article  Google Scholar 

  40. Perani D, Vallar G, Cappa S, Messa C, Fazio F (1987) Aphasia and neglect after subcortical stroke. A clinical/cerebral perfusion correlation study. Brain 110:1211–1229

    Article  Google Scholar 

  41. Peterslund NA (1988) Herpes zoster associated encephalitis: clinical findings and acyclovir treatment. Scand J Infect Dis 20:583–592

    CAS  Article  Google Scholar 

  42. Peterslund NA, Hansen JH (1989) Electroencephalographic changes in patients with herpes zoster. Acta Neurol Scand 79:407–411

    CAS  Article  Google Scholar 

  43. Pozzilli C, Passafiume D, Bernardi S, Pantano P, Incoccia C, Bastianello S, Bozzao L, Lenzi GL, Fieschi C (1991) SPECT, MRI and cognitive functions in multiple sclerosis. J Neurol Neurosurg Psychiatry 54:110–115

    CAS  Article  Google Scholar 

  44. Price RW, Brew B, Sidtis J, Rosenblum M, Scheck AC, Cleary P (1988) The brain in AIDS: central nervous system HIV-1 infection and AIDS dementia complex. Science 239:586–592

    CAS  Article  Google Scholar 

  45. Reshef E, Greenberg SB, Jankovic J (1985) Herpes zoster ophthalmicus followed by contralateral hemiparesis: report of two cases and review of literature. J Neurol Neurosurg Psychiatry 48:122–127

    CAS  Article  Google Scholar 

  46. Roine RO, Launes J, Nikkinen P, Lindroth L, Kaste M (1991) Regional cerebral blood flow after human cardiac arrest. A hexamethylpropyleneamine oxime single photon emission computed tomographic study. Arch Neurol 48:625–629

    CAS  Article  Google Scholar 

  47. Rose CF, Brett EM, Burston J (1964) Zoster encephalomyelitis. Arch Neurol 11:155–172

    CAS  Article  Google Scholar 

  48. Rose FC, Symonds CP (1960) Persistent memory defect following encephalitis. Brain 83:195–212

    CAS  Article  Google Scholar 

  49. Ruppenthal M (1980) Changes of the central nervous system in herpes zoster. Acta Neuropathol (Berl) 52:59–68

    CAS  Article  Google Scholar 

  50. Shoqeirat MA, Mayes A, MacDonald C, Meudell P, Pickering A (1990) Performance on tests sensitive to frontal lobe lesions by patients with organic amnesia: Leng & Parkin revisited. Br J Clin Psychol 29:401–408

    Article  Google Scholar 

  51. Steele RW, Keeney RE, Bradsher RW, Moses EB, Soloff BL(1983) Treatment of varicella-zoster meningoencephalitis with acyclovir – demonstration of virus in cerebrospinal fluid by electron microscopy. Am J Clin Pathol 80:57–60

    CAS  Article  Google Scholar 

  52. Wechsler D (1954) Standardized memory scale for clinical use. J Psychol 19:87–95

    Article  Google Scholar 

  53. Wechsler D (1955) Wechsler Adult Intelligence Scale. The Psychological Corporation, New York

    Google Scholar 

  54. Whitley RJ (1990) Viral encephalitis. N Engl J Med 323:242–250

    CAS  Article  Google Scholar 

  55. Whyte MK, Ind PW (1986) Effectiveness of intravenous acyclovir in immunocompetent patient with herpes zoster encephalitis. BMJ 293:1536–1537

    CAS  Article  Google Scholar 

  56. Wolfson LI, Leenders KL, Brown LL, Jones T (1985) Alterations of regional cerebral blood flow and oxygen metabolism in Parkinson’s disease. Neurology 35:1399–1405

    CAS  Article  Google Scholar 

  57. Ylikoski R, Ylikoski A, Erkinjuntti T, Sulkava R, Raininko R, Tilvis R (1993) White matter changes in healthy elderly persons correlate with attention and speed of mental processing. Arch Neurol 50:818–824

    CAS  Article  Google Scholar 

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Hokkanen, L., Launes, J., Poutiainen, E. et al. Subcortical type cognitive impairment in herpes zoster encephalitis. J Neurol 244, 239–245 (1997). https://doi.org/10.1007/s004150050078

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  • DOI: https://doi.org/10.1007/s004150050078

Key words

  • Neuropsychological tests
  • Subcortical dementia
  • Herpes zoster encephalitis
  • Varicella zoster virus