Can herpes affect the cerebral cortex. Can you get a headache from herpes? Herpetic brain damage is a necrotic process, therefore, after the disease, there is a high probability of developing neurological consequences - both temporarily

Herpes cerebralHerpes cerebral is an inflammatory disease that leads to changes in the brain; it progresses rapidly. Herpetic encephalitis is caused by the herpes simplex virus of the first type (HSV-1), less often of the second (HSV-2). This family of viruses includes the causative agent of herpes zoster, chickenpox, mononucleosis, and cytomegalovirus.

This disease is the most common among encephalitis. In most people who are carriers of the virus, this infection seems to lie dormant in the brain and wakes up with various brain injuries, from medications, hypothermia or overheating. In the remaining part of patients, infection occurs from external causes. Studies have shown that herpes brain infection occurs in the spring.

Pathogenesis and transmission routes

Mechanism of reproduction of the herpes virus Herpes infection in the form of encephalitis is observed in childhood and young age. The virus enters the central nervous system of the brain through the mucous membrane of the nasal passages, moves along the axons of the olfactory neurons into the olfactory bulb and spreads to the central nervous system along the nerves. Adults who develop a herpes infection are most often already carriers or susceptible to the first type of virus. HSV is very contagious, which means it is easy to catch. Even animals can get sick from it, but if a person has a strong immune system, then the disease can be avoided.

Routes of transmission: airborne, sexual, contact, from mother to child during childbirth and during breastfeeding. When immunity decreases, there may be a rash on the body. The virus itself is stable in the environment and can exist outside the body for a long time. It dies at temperatures above 50 degrees within half an hour and below 70 degrees it is destroyed in 5 days. Survives well in humid environments.

Clinical manifestations

Herpes cerebralThe latent period lasts from 2 to 20 days, most often it is a week. Symptoms of the disease begin with tingling and pain in the areas where the rash appears. This whole process lasts a day, after which all symptoms and pain begin to appear more intense. HSV is usually localized in the gray matter of the brain in the frontal and temporal lobes; less commonly, the trunk is affected where the center of breathing and heartbeat is. Symptoms depend on its location.

The temperature rises to a critical level (39-40 degrees), it does not decrease with medications. Weakness appears, then convulsive syndrome occurs, muscle contraction occurs both in the whole body and in individual groups. Seizures recur frequently and are difficult to treat. Consciousness becomes confused, the patient is stunned, and a coma develops with loss of consciousness. There may be double vision, pain when moving the eyeballs, or the patient cannot look to the side. The appearance of strabismus, restrictions in movements of the arms or legs and weakness in them. There may be paresis of half the body, instability in the Romberg position, and unsteadiness of gait. Slurred speech, agitation, hallucinations, memory loss, headache, changes in pulse and blood pressure.

Diagnosis and treatment

It is difficult to distinguish herpes brain from other changes associated with damage to the brain and central nervous system. To determine a herpes infection, you need to do PCR to determine its DNA. Another main method is a brain biopsy.

Read more about diagnosing herpes.

If a person has a rash, weakness, pain and other symptoms of herpetic encephalitis, then he needs to be hospitalized immediately. The outcome of treatment and the rehabilitation period depend on the timely detection of the form of the virus.

To ensure rest during a herpes brain infection, you need to eliminate all irritating factors, reduce activity, provide the patient with bed rest and plenty of warm drinks. To suppress the symptoms of herpes, antiviral medications are prescribed. They are selected for the specific virus that caused the disease.

If there is a headache, then painkillers are prescribed to eliminate weakness and increase immunity. For fever - antipyretics, anti-inflammatory drugs are also needed, B vitamins also eliminate weakness, to improve memory - nootropics and symptomatic therapy. When the body is dehydrated and to remove toxins, drip infusions of solutions are used. In severe cases, the patient is transferred to mechanical ventilation, oxygen is given, anticonvulsants are administered, and diuretics are administered to eliminate edema.

Complications and rehabilitation

The consequences of herpetic encephalitis include: meningitis, migraine or just headache, dizziness, impaired vision, hearing, speech, there may be constant weakness, partial memory loss, muscle weakness, paresis, decreased mental activity, various mental disorders. But complications are rare and resolve over time in almost everyone.

They do not go away in people with constant mental fatigue, inadequate treatment, pregnancy, or constant consumption of alcohol. If complications occur, rehabilitation measures are necessary.

Special centers have an individual program for restoring health; medical workers seek an individual approach to each patient. They use therapeutic exercises, physiotherapy, various methods of movement therapy, such methods restore all functions of the joints, eliminate muscle weakness and pain. Occupational therapy is the gradual return of the patient to life. Various specialists allow you to recover from herpes brain.

Herpes infection in newborns

From 1:3000 to 1:20000 is the number of children who were born with HSV. They are born prematurely, malformations are rare, newborns weigh less than usual, they have muscle weakness, and decreased tone. The clinic takes place in three forms.

• Local, this stage is the simplest; damage to the mucous membranes and skin occurs. But if it is not treated, it will turn into another with damage to the central nervous system.
• Local form – herpetic encephalitis, meningitis. Cysts and necrosis appear in the temporal and frontal lobes.
• The disseminated stage is the most severe. The liver, central nervous system, adrenal glands, and lungs are affected and DIC syndrome develops.

vysypanie.ru

• 1 Etiology
• 2 The process of development of the disease
• 3 Symptoms
• 4 Diagnosis and treatment

Herpes brain (herpetic encephalitis) is a serious and dangerous disease that manifests itself in the form of inflammation with a rapid course, which leads to changes in the brain. Certain strains of herpes simplex, namely HSV-1 and HSV-2, can cause this disease.

The herpes virus contains DNA chains, has a size of 150 nanometers and a covering shell consisting of lipids. When the human body is infected, it penetrates inside the cells, where it divides, but does not cause any harm - the latent stage (inactive). As soon as the body succumbs to the influence of certain factors, the pathogen enters the reactivity stage. In most cases, the pathology occurs in people 5-30 years old; after 50, it most often acts as a complication.

The herpetic type is the most common form among all known encephalitis. In many patients who carry the herpes virus pathogen in their body, this infection has settled in the brain and is activated in the event of any injury to the organ. This can happen while taking certain medications or prolonged exposure to low or high temperatures. For the rest, infection occurs from exogenous causes. Studies have found that the peak increase in infection cases occurs in the spring.

Etiology

The causative agent of the disease is a member of the herpes family (Herpes viridae), which also includes chickenpox virus, herpes zoster, cytomegalovirus, etc. It has DNA and actively multiplies inside the cells of the body, forming intranuclear inclusions. When certain types of cells (for example, neurons) are affected, the process of pathogen replication and cell death is absent. Instead, the cell exerts a specific inhibitory effect on the virus, causing it to enter the latency stage. Sometimes, it is possible to identify a reactivation process that brings the virus from a dormant state to a manifest one.

According to the isolated structure of antigens to herpes, HSV is divided into 2 types. The genomes of strains 1 and 2 are 50% homologous. HSV-1 often affects the respiratory system. HSV-2 is a typical causative agent of such pathologies as genital herpes and generalized herpes in newborns.

The infection can be transmitted by contact or droplets.

The process of disease development

In a young body, the primary herpes virus is capable of taking the form of encephalitis herpes. In this situation, pathogens enter the human central nervous system from the mucous membrane of the nasal cavity, moving along unequal fibers that are responsible for the sense of smell. But many adults suffering from encephalitic herpes already have episodes of the disease in the past, or they are active carriers of the HSV-1 virus.

Every 4 patients with brain herpes show the presence of different varieties of the virus during laboratory analysis of materials from the mucous membrane of the oropharynx. In such cases, brain inflammation can be explained by repeated infection with HSV-1 with its subsequent introduction into the central nervous system.

In order to describe in detail the reasons for the development of the inflammatory process of the brain, namely those cases when strains of the same species were found on the mucous membrane of the oropharynx and in the tissues of the brain, 2 hypotheses were made:

1. The first says - a recurrent manifestation of the herpetic encephalitis virus in the trigeminal or autonomic ganglia, with spread to the parts of the central nervous system along the nerve fibers.
2. The second hypothesis is that herpes remains in a latent state for a very long time immediately in the central nervous system, where it is reactivated.

Symptoms

Encephalitic herpes likes to affect the temporal and frontal lobes of the brain, where necrotization and hemorrhagic lesions most often occur.

The main symptoms may manifest themselves in different ways, depending on the severity and location of the affected area of ​​the brain. Experts have identified a specific triad of symptoms that are characteristic specifically of herpetic inflammation:

1. Acute fever – sudden hyperthermia of the body (up to 39 degrees). It is difficult to bring down such a temperature, even by taking antipyretic drugs.
2. Jacksonian type seizures - they can affect the entire body or certain areas of it.
3. Disorder of consciousness - ranging from short-term oblivion to deep coma (this disorder is almost always disappointing, since in 90% of cases, people immersed in a coma do not survive).

These signs will certainly manifest themselves in all infected people, but there are also some among them that are purely individual for each specific case. These include:

• Dysfunction of the oculomotor nerve - patients may experience strabismus and a feeling of double vision.
• Rapid hallucinations (a common phenomenon that accompanies other central nervous system pathologies and requires immediate treatment).
• Increased sweating.
• Short-term memory loss.
• Unsteadiness when walking.
• Monoparesis or a disorder of motor functionality on one side of the body (the result of damage to the temporal lobe of the brain).
• Excited state.
• Speech disorder.

In addition, damage to the brain of a herpetic nature can be assumed by such signs as an increase in protein content in the cerebrospinal fluid, a high level of ESR and lymphopenia. Infants may develop decortication or hydrocephalus.

Diagnosis and treatment

It is difficult to diagnose encephalitis caused by herpes, distinguishing it from other types of inflammation and lesions of the central nervous system of various types. The most informative method of early diagnosis, which does not require invasive interventions in the brain and is highly accurate, is the detection of herpes simplex virus DNA in the spinal cord cerebrospinal fluid using the PCR method.

The amount of antibodies to HSV that was obtained from the studied body fluids (cerebrospinal fluid or serum) in herpetic encephalitis often increases, and this happens during the first 10 days of the disease.

Considering these nuances, serological research methods are suitable only for retrospective diagnosis. Carrying out a biopsy provides an excellent opportunity to detect traces of antigens and DNA of the herpes virus, which is localized in brain tissue, and to subsequently isolate the type of virus in cell culture. A method with very high sensitivity, which also has a low incidence of complications. In addition, a biopsy allows you to diagnose other types of brain inflammation that may be present.

The sick person is isolated and placed in the intensive care unit or intensive care unit. The main drug that has a suppressive effect on the virus and can relieve all symptoms is Acyclovir. Most people know it from products based on it, which are intended for external use, but to treat brain damage, injectable and oral forms must be used.

The first days of the treatment course begin with high doses of drugs to introduce it into the body. This treatment regimen can reduce the mortality rate from 70% to 5% and, in addition, will significantly reduce the risk of complications such as disability.

Many doctors consider it necessary to prescribe interferons during treatment (Cycloferon, Viferon, etc.), but specialists from Western clinics who conducted tests did not confirm their high effectiveness in the fight against the herpes simplex virus.

In a hospital setting, the patient is prescribed mandatory detoxification of the body and dehydration (restoration of water-salt balance). To relieve swelling of the brain, glucocorticosteroids, tracheal intubation, and ventilation are used.

• Ventilation of premises.
• Carefully wash your hands with soap after going outside and before eating food.
• Compliance with basic rules of personal hygiene.
• During outbreaks of infection, it is recommended to avoid places with large crowds of people.
• Great attention should be paid to the prevention of newborns.
• It is important to begin timely treatment of exacerbation of herpes on the lips and genitals.

herpeshelp.ru

Questions

Herpes brain is an acute inflammatory disease of a viral nature. This condition is caused by herpes simplex virus type 1 or 2 when the microorganism invades brain cells, causing inflammation. This inflammation of the central nervous system caused by herpes viruses is called herpetic encephalitis, or in common parlance - herpes brain.

Herpetic encephalitis most often develops in young children or in newborns infected with the virus from their mother. Herpes of the brain can develop both in response to the initial penetration of the virus into the body, and may represent an exacerbation of asymptomatic virus carriage. In children, herpetic encephalitis most often represents a primary process when the virus enters the body for the first time in life. The herpes virus, once on the mucous membranes of the upper respiratory tract, penetrates the branches of the nerves, and then moves along them, reaching the structures of the brain. Once in the brain, the virus leads to the development of herpetic encephalitis.

In older people, herpetic encephalitis is not a primary process. That is, once a person was infected with a herpes virus, which became active and gradually penetrated the structures of the brain. Currently, the exact causes and routes of penetration of the herpes virus into the brain have not been established.

Herpetic encephalitis is characterized by an acute febrile onset, the appearance of seizures and impaired consciousness. Inflammation of the brain develops after a short acute respiratory illness. In addition to these general symptoms, paresis of the oculomotor nerves, hemiparesis and speech disorder appear.

In the cerebrospinal fluid with herpetic encephalitis, the number of lymphocytes increases to 30 - 400 G/l and the protein concentration increases to 1.32 g/l. However, these changes in the composition of the cerebrospinal fluid appear only after 3–5 days from the onset of the disease. In a general blood test, an increase in the total number of leukocytes and band neutrophils is noted, and the number of lymphocytes also decreases. In addition, ESR is increased, as with any other inflammatory process.

If the course of encephalitis is unfavorable, the person falls into a coma, which can lead to death. If herpes encephalitis is not treated with antiviral drugs, the mortality rate from this infection is 70–75%. However, even with the correct and timely use of antiviral drugs, 20–25% of people who develop herpetic encephalitis die.

After recovery, a large number of people experience residual effects in the form of seizures or mental impairment. Infants may develop hydrocephalus or complete melting of the cerebral cortex.

Diagnosing herpetic encephalitis is quite difficult because there are no specific signs. And identifying the viral nature of encephalitis is necessary in order to begin proper treatment in a timely manner. Currently, in order to diagnose herpetic encephalitis, virus detection using PCR in a biopsy of the brain or cerebrospinal fluid is used.

Treatment of herpetic encephalitis is carried out in an intensive care unit due to the high risk of developing respiratory disorders. The main drug for the treatment of encephalitis is acyclovir (Zovirax, Virolex, etc.), which is administered in the form of intravenous injections. In addition, interferon drugs and other immunostimulants are used to enhance the immune response and help the body cope with the herpes virus. In order to suppress inflammation, it is necessary to use glucocorticoids - Dexamethasone, Cortisone, etc.

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Herpetic brain damage

Herpes brain is a disease that occurs as a result of penetration of the herpes virus under the meninges. In most cases, brain damage is caused by the form that causes rashes on the lips; in 5% of cases, encephalitis is caused by genital herpes.

Children under 5 years of age, as well as older people (after 55), are most often affected. This is due to a decrease in immune resistance. The first category is characterized by the occurrence of a primary infection, but in adults there is activation of a virus that has been “sleeping” in the body for a long time.

Clinical picture

Symptoms of herpes brain begin to appear against the background of other diseases: external herpes, pharyngitis, stomatitis and other respiratory lesions. The clinical picture begins acutely. The medulla quickly swells and becomes inflamed, cells die and areas of necrosis form. Damage to brain tissue is of various types:

1. Diffuse: the entire brain or a large area of ​​it is involved in the process. This pathology is typical for young children.
2. Focal: a limited part of the brain is affected.

The pathological process involves gray and white matter. Often the inflammation spreads to the cerebral cortex.

The main symptoms of herpetic encephalitis:

• fever with a significant increase in temperature, sometimes up to 41 degrees;
• Jacksonian seizures - convulsive muscle contractions that begin on one side, but soon cover the entire body;
• nausea, vomiting that does not bring relief;
• paralysis and paresis;
• inability to normally control body movements (see Ataxia);
• unbearable headaches that are difficult to respond to medications;
• the appearance of hallucinations, delusional states, aggressiveness.

If the course of the disease is very severe, or in the case where no treatment has been carried out, the pathological process spreads to the spinal cord. Symptoms of damage to the latter appear.

The mechanism of development of the disease herpes zoster and the causes of the pathology.

Learn about the symptoms and consequences of chickenpox encephalitis: consequences of the disease.

Symptoms of brain herpes in young children are more severe than in adult patients. Often in the first phase, depression of consciousness quickly occurs, the child falls into a coma, from which it is difficult to bring him out. The negative effect of infection on the brain manifests itself in the form of convulsions of the whole body, up to opisthotonus.

Seizures are very difficult to stop. And even if the child can be brought back to consciousness, there is a high risk of developing problems with written and spoken speech, and some motor skills may be lost. In such patients, memory almost always suffers, especially short-term memory.

Chronic damage is characterized by sluggish development of pathology. The disease can develop for months without making itself felt. The only symptoms that indicate the disease are periodic increases in temperature to low-grade fever (37-38 degrees), weight loss, weakness, and drowsiness.

The asthenic state is manifested by quickly onset fatigue, headaches, and decreased performance. After approximately 6–8 months, the clinical picture begins to develop and the following symptoms appear:

• muscle dystonia – too much tension or, conversely, hypotonicity;
• transient paralysis, which is often localized only on one part of the body;
• short-term seizures;
• differences in reflexes on different sides of the body.

Unlike the acute course, chronic encephalitis does not cause disturbances in the consciousness and psyche of a person. Exceptions are advanced cases when there is deep damage to brain tissue.

To make an accurate diagnosis, a series of examinations are performed on the patient. To exclude traumatic or oncological causes, the following methods are used:

• Magnetic resonance imaging;
• rheoencephalography;
• CT scan.

If more than 10 days have passed since infection, cerebrospinal fluid or blood tests are prescribed, which reveal an increase in the titer of antibodies to the herpes virus. Sometimes doctors prescribe a biopsy of the affected area of ​​the brain. But since this method is associated with enormous risks, it is performed extremely rarely.

First of all, you need to get rid of the cause, that is, the virus. For this purpose, Acyclovir is prescribed. In the first 5-7 days, large doses of the drug are administered to quickly suppress the activity of the virus, then a maintenance dosage is prescribed to prevent relapses. In addition, antiviral drugs such as Cycloferon or the like are used for treatment.

All patients require symptomatic therapy:

• to relieve swelling of the medulla, diuretics (Lasix, Furosemide, Mannitol) and glucocorticosteroid drugs (Hydrocortisone, Prednisolone) are prescribed;
• in case of problems with respiratory function, the patient is transferred to a special device that performs artificial ventilation of the lungs;
• To prevent attacks of aggression and overexcitation, the patient is sedated using Relanium, Aminazine or similar agents.

Learn about the symptoms of herpetic encephalitis in children and newborns.

Read what brain toxoplasmosis leads to: symptoms and treatment, complications of the pathology.

All about meningococcal meningitis in children: symptoms, treatment and complications. How do children become infected with meningococcus?

Disease prognosis

Herpes brain is an extremely dangerous pathology that leads to serious consequences and death. The disease is especially difficult for young children and the elderly. To avoid complications, you need to be careful about your health and consult a doctor on time. In the case of herpetic encephalitis, treatment started at the onset of the disease is the key to successful recovery.

Herpetic encephalitis is an acute inflammation of the white and gray matter of the head caused by the herpes simplex virus types 1, 2. Among the various forms of encephalitis, herpetic encephalitis is the most common and severe, both in its course and in treatment.

Herpevirus is a DNA virus. About 80% of people are infected with this virus, which manifests itself as papular rashes on the mucous membranes of the lips, nose, eyes, genitals and skin. But, in some cases, more often in people with reduced immunity, herpes affects the brain surface. Children, old people, people with immunodeficiencies are at risk.

The incidence may also be seasonal.. Researchers note that in spring and autumn, the incidence of gray matter herpes increases, which is associated with the body’s overall resistance, which decreases during these periods.

Mechanism of disease development

Scientists identify two ways of developing herpetic encephalitis:

• The first is primary infection. The herpevirus enters the mucous membrane of the nose or mouth, and, since it is tropic for nervous tissue, penetrates the axons of the smelling nerves, from where it spreads throughout the nervous system - into the nerve ganglia and the brain.
• The second is the activation of the virus. In carriers, due to decreased immunity (stress, trauma, poor nutrition, diseases that cause immunodeficiency - tuberculosis, rheumatism, cancer, AIDS), the virus becomes active and affects the tissue of the cerebral convolutions, namely the lower part of the frontal lobe and the temporal lobe. Cell damage is accompanied by swelling, inflammation, and cell death.

Symptoms

Common characteristic features are:

• acute respiratory infection with herpetic rashes suffered the day before;
• acute increase in body temperature to 39 degrees and above, which is difficult to treat;
• disturbances of consciousness of varying severity - from general lethargy to coma;
• convulsions of the whole body or parts of it.

All other symptoms are purely individual, as they depend on which area is affected.

It can be:

• various paresis;
• speech disorders;
• auditory or visual hallucinations;
• confusion;
• epileptic seizures;
• violation of autonomic functions, up to cardiac arrest;
• headache.

Diagnostics

The diagnosis of herpetic encephalitis can be made on the basis of clinical data in combination with laboratory and instrumental studies.

Spinal puncture and analysis of cerebrospinal fluid for viral DNA is a mandatory research method. Using polymerase chain reaction (PCR), identifying the virus is simple and quick. Computed tomography or nuclear magnetic resonance imaging is also prescribed, which allows identifying foci of tissue necrosis in the brain. The disadvantage of this study is that in the first stages of the disease there are no structural changes in the organ; they appear on the 4-5th day of the disease.

A biopsy and examination of the biopsy sample for the presence of a virus are quite informative, but due to the traumatic nature of the method and the high risk of complications, it is rarely used.

Treatment

Patients should be immediately hospitalized in the intensive care unit.

There is specific therapy for herpetic encephalitis - acyclovir, herpevir. The dose, frequency of administration and dosage form depend on the severity of the disease and are determined by the attending physician.

Immunomodulators and interferons, corticosteroids are also prescribed to significantly increase the effect of antiviral therapy. At the same time, detoxification therapy, dehydration and symptomatic agents are used.

Consequences and prevention

Herpes of the brain can go away without consequences, but sometimes undesirable complications remain:

• epilepsy;
• personality and intellectual disorders;
• paralysis and paresis.

The changes are persistent and cannot be treated, since they appear as a result of structural disorders in the brain. If patients with encephalitis of herpes etiology are not treated, death occurs in more than 80% of cases.

Herpes brain is a viral disease. Its appearance is provoked by viruses of types 1 and 2, which, when entering the human body, cause inflammatory processes in it. This kind of inflammation is called encephalitis. This disease is common in newborns infected with the virus from their mother, or in young children. It can develop as a result of a primary infection of the body, or appear as a result of an exacerbation against the background of reduced immunity in the body of the virus carrier. The virus first enters the upper respiratory tract, then onto the branches of the nerves, along which it “makes its way” to the head. This is how herpes occurs in the brain.

In adults, the primacy of this diagnosis is questionable. Most often, the virus develops against a background of weakened immunity after it has entered the body.

The reasons for the appearance and the exact routes of penetration of the virus into the brain (more precisely, into the temporal and lower part of the frontal lobe) have not been established.

Herpes brain: symptoms

Signs of the disease under study include the following symptoms:

• acute fever
• convulsions
• disturbance of consciousness
• paresis of the oculomotor nerves
• hemiparesis
• speech disorder

In a general blood test, the number of leukocytes and band neutrophils increases significantly, and the number of lymphocytes, on the contrary, decreases. As with any other inflammatory process, ESR increases.

Herpes brain is a very dangerous disease. If treatment is not started in time, rapid death is possible. But even with correct and timely treatment, 20-25% of patients with this diagnosis die. After recovery, difficulty in thinking and convulsions remain.

Diagnosing herpetic encephalitis is quite difficult, since the disease does not have specific symptoms. In modern medicine, it is detected by PCR determination in a brain biopsy (or cerebrospinal fluid). Since there is a high probability development of respiratory disorders in this disease, it is treated only in intensive care conditions. The drug Acyclovir is administered intravenously, interferons and other immunomodulators are used, which stimulate the body’s “response” protective reaction to the virus. To combat inflammatory processes, glucocorticoids are used - Dexamethasone, Cortisone and similar drugs.

So, herpes brain is a dangerous and unpredictable disease. Virus carriers should be vigilant and consult a doctor promptly if primary symptoms of the disease are detected.

Herpes brain (herpetic encephalitis) is a serious and dangerous disease that manifests itself in the form of inflammation with a rapid course, which leads to changes in the brain. Certain strains of herpes simplex, namely HSV-1 and HSV-2, can cause this disease.

The herpes virus contains DNA chains, has a size of 150 nanometers and a covering shell consisting of lipids. When the human body is infected, it penetrates inside the cells, where it divides, but does not cause any harm - the latent stage (inactive). As soon as the body succumbs to the influence of certain factors, the pathogen enters the reactivity stage. In most cases, the pathology occurs in people 5-30 years old; after 50, it most often acts as a complication.

The herpetic type is the most common form among all known encephalitis. In many patients who carry the herpes virus pathogen in their body, this infection has settled in the brain and is activated in the event of any injury to the organ. This can happen while taking certain medications or prolonged exposure to low or high temperatures. For the rest, infection occurs from exogenous causes. Studies have found that the peak increase in infection cases occurs in the spring.

Etiology

The causative agent of the disease is a member of the herpes family (Herpes viridae), which also includes chickenpox virus, herpes zoster, cytomegalovirus, etc. It has DNA and actively multiplies inside the cells of the body, forming intranuclear inclusions. When certain types of cells (for example, neurons) are affected, the process of pathogen replication and cell death is absent. Instead, the cell exerts a specific inhibitory effect on the virus, causing it to enter the latency stage. Sometimes, it is possible to identify a reactivation process that brings the virus from a dormant state to a manifest one.

According to the isolated structure of antigens to herpes, HSV is divided into 2 types. The genomes of strains 1 and 2 are 50% homologous. HSV-1 often affects the respiratory system. HSV-2 is a typical causative agent of such pathologies as genital herpes and generalized herpes in newborns.

The infection can be transmitted by contact or droplets.

The process of disease development

In a young body, the primary herpes virus is capable of taking the form of encephalitis herpes. In this situation, pathogens enter the human central nervous system from the mucous membrane of the nasal cavity, moving along unequal fibers that are responsible for the sense of smell. But many adults suffering from encephalitic herpes already have episodes of the disease in the past, or they are active carriers of the HSV-1 virus.

Every 4 patients with brain herpes show the presence of different varieties of the virus during laboratory analysis of materials from the mucous membrane of the oropharynx. In such cases, brain inflammation can be explained by repeated infection with HSV-1 with its subsequent introduction into the central nervous system.

In order to describe in detail the reasons for the development of the inflammatory process of the brain, namely those cases when strains of the same species were found on the mucous membrane of the oropharynx and in the tissues of the brain, 2 hypotheses were made:

1. The first says - a recurrent manifestation of the herpetic encephalitis virus in the trigeminal or autonomic ganglia, with spread to the parts of the central nervous system along the nerve fibers.
2. The second hypothesis is that herpes remains in a latent state for a very long time immediately in the central nervous system, where it is reactivated.

Symptoms

Encephalitic herpes likes to affect the temporal and frontal lobes of the brain, where necrotization and hemorrhagic lesions most often occur.

The main symptoms may manifest themselves in different ways, depending on the severity and location of the affected area of ​​the brain. Experts have identified a specific triad of symptoms that are characteristic specifically of herpetic inflammation:

1. Acute fever – sudden hyperthermia of the body (up to 39 degrees). It is difficult to bring down such a temperature, even by taking antipyretic drugs.
2. Jacksonian type seizures - they can affect the entire body or certain areas of it.
3. Disorder of consciousness - ranging from short-term oblivion to deep coma (this disorder is almost always disappointing, since in 90% of cases, people immersed in a coma do not survive).

These signs will certainly manifest themselves in all infected people, but there are also some among them that are purely individual for each specific case. These include:

• Dysfunction of the oculomotor nerve - patients may experience strabismus and a feeling of double vision.
• Rapid hallucinations (a common phenomenon that accompanies other central nervous system pathologies and requires immediate treatment).
• Increased sweating.
• Short-term memory loss.
• Unsteadiness when walking.
• Monoparesis or a disorder of motor functionality on one side of the body (the result of damage to the temporal lobe of the brain).
• Excited state.
• Speech disorder.

In addition, damage to the brain of a herpetic nature can be assumed by such signs as an increase in protein content in the cerebrospinal fluid, a high level of ESR and lymphopenia. Infants may develop decortication or hydrocephalus.

Diagnosis and treatment

It is difficult to diagnose encephalitis caused by herpes, distinguishing it from other types of inflammation and lesions of the central nervous system of various types. The most informative method of early diagnosis, which does not require invasive interventions in the brain and is highly accurate, is the detection of herpes simplex virus DNA in the spinal cord cerebrospinal fluid using the PCR method.

The amount of antibodies to HSV that was obtained from the studied body fluids (cerebrospinal fluid or serum) in herpetic encephalitis often increases, and this happens during the first 10 days of the disease.

Considering these nuances, serological research methods are suitable only for retrospective diagnosis. Carrying out a biopsy provides an excellent opportunity to detect traces of antigens and DNA of the herpes virus, which is localized in brain tissue, and to subsequently isolate the type of virus in cell culture. A method with very high sensitivity, which also has a low incidence of complications. In addition, a biopsy allows you to diagnose other types of brain inflammation that may be present.

The sick person is isolated and placed in the intensive care unit or intensive care unit. The main drug that has a suppressive effect on the virus and can relieve all symptoms is Acyclovir. Most people know it from products based on it, which are intended for external use, but to treat brain damage, injectable and oral forms must be used.

The first days of the treatment course begin with high doses of drugs to introduce it into the body. This treatment regimen can reduce the mortality rate from 70% to 5% and, in addition, will significantly reduce the risk of complications such as disability.

Many doctors consider it necessary to prescribe interferons during treatment (Cycloferon, Viferon, etc.), but specialists from Western clinics who conducted tests did not confirm their high effectiveness in the fight against the herpes simplex virus.

In a hospital setting, the patient is prescribed mandatory detoxification of the body and dehydration (restoration of water-salt balance). To relieve swelling of the brain, glucocorticosteroids, tracheal intubation, and ventilation are used.

• Ventilation of premises.
• Carefully wash your hands with soap after going outside and before eating food.
• Compliance with basic rules of personal hygiene.
• During outbreaks of infection, it is recommended to avoid places with large crowds of people.
• Great attention should be paid to the prevention of newborns.
• It is important to begin timely treatment of exacerbation of herpes on the lips and genitals.

Herpetic encephalitis ranks first in prevalence among infectious brain lesions. In half of the cases it affects children and young people under 20 years of age, as well as the older age group after 50 years of age. Before the use of Acyclovir, mortality reached 70%; today this figure is 28%. The disease has a severe course and is often accompanied by neurological complications.

Why does herpes affect the brain?

According to statistics, about 80% of the population are carriers of the herpes simplex virus. The main clinical manifestations of the infection are characteristic rashes on the lips, less often on the genitals. For unknown reasons, the virus affects the brain in some people. The mechanism of development of the disease is explained by two theories:

1. The virus penetrates the mucous membranes and reaches the vegetative nodes along the nerve processes. There the pathogen replicates, and it enters the brain along nerve fibers.
2. The virus also reaches the nerve nodes and enters a latent state. The inactive infectious agent is transferred to the brain tissue, where it is activated and starts the entire pathological process.

The development of herpetic meningoencephalitis in a third of all patients occurs after the first contact with the virus. In 2/3 of patients, encephalitis develops as a reactivation of a latent infection.

In a dormant state, the viral agent is located in the bulb of the olfactory trigeminal nerve. Along it, it spreads to the temporal and frontal lobes of the brain. This explains the main symptoms of the disease and the formation of foci of necrosis only in these areas.

But meningoencephalitis caused by herpes does not develop in all infected people. It has been established that there is a predisposing factor in the form of innate characteristics of the immune system. The reason lies in a mutation or deficiency of certain genes. Acquired immunodeficiency or decreased immunity as a result of taking medications rarely leads to encephalitis herpes.

How to recognize pathology

The incubation period lasts from 2 to 14 days. After it, a prodromal period is characteristic, in which signs of general malaise, weakness, and decreased performance appear. Herpes acute encephalitis of the brain develops with the following symptoms:

Sometimes convulsions and loss of consciousness precede a rise in temperature. The disease is accompanied by additional neurological signs that do not appear in every patient. Paresis of oculomotor nerves, unilateral paralysis, and various types of aphasia may be observed. Patients confuse words, cannot express their thoughts orally, and their writing technique is impaired. Some have difficulty manipulating objects and cannot perform small movements with their hands. Sometimes there are olfactory hallucinations, disorientation in space and time, and amnesia. Personality changes are common.

Encephalitis in children

The virus can be transmitted to a newborn child during childbirth or in utero, much less often after birth. Signs of encephalitis appear during the first month of life. The rate of development of symptoms depends on the characteristics of the child’s body and full term.

The most severe signs are recorded in premature babies. Impairment of respiratory function and swallowing reflex may develop, and convulsions may appear. There are no skin rashes.

In older children, a clinical picture is observed that resembles the course of the disease in adults. The prognosis of the disease is not always favorable. The consequences may be:

• mental retardation;
• blindness;
• deafness;
• hydrocephalus;
• muscle spasticity.

Often children who have had the disease remain disabled.

Diagnostic methods

It is impossible to diagnose herpetic encephalitis based only on complaints and clinical picture. A thorough examination is required, the purpose of which is to differentiate the causative agent of the disease.

Most often, to diagnose herpetic meningoencephalitis, a lumbar puncture is used, followed by a study of the cerebrospinal fluid using the PCR method. When analyzing the cerebrospinal fluid, an increased number of leukocytes is determined. Instead of clear, the liquor becomes xanthochrome - a special shade of yellow. It increases the content of protein and glucose.

A portion of the cerebrospinal fluid is sent for PCR diagnostics. The purpose of the study is to detect DNA of herpes types 1 and 2.

In the first 72 hours after the onset of clinical symptoms, PCR may give a false negative result. If there are characteristic signs of brain damage by herpes and MRI data, a repeat puncture is prescribed on the 4th day of the disease.

Neuroimaging of the brain is mandatory. The most specific method is MRI. During the first 24 hours, CT scan has a sensitivity of less than 50%, so it is not advisable to use it.

If MRI and CT cannot be performed, an EEG is performed. This method has higher sensitivity than computed tomography, but is not specific enough. The encephalitic recording corresponds to high-amplitude sharp waves and slow wave complexes, which are observed in the temporal leads. If a normal EEG is recorded from the first days of illness, this is a favorable prognostic sign.

Virological testing is not performed. This is a very long and expensive method, which is based on growing the virus in special nutrient media. Serological diagnosis is not used due to low objectivity and accuracy.

General blood tests are carried out, in which signs of inflammation are observed - an increase in the number of leukocytes, acceleration of ESR.

Therapy methods

Treatment of herpesvirus is carried out in the intensive care unit in the intensive care unit. The main therapeutic drug is Acyclovir. Other antiviral agents (Famciclovir) are also used. Medicines in large doses are administered intravenously.

Combating complications includes prescribing broad-spectrum antibiotics to prevent the development of a bacterial infection in a bedridden patient. The rest of the therapy is symptomatic. Drip administration of water-salt solutions and glucose is prescribed to maintain brain function, correct the basic balance and detoxify. Cardiac activity and respiratory function are constantly monitored, and measures are taken to prevent cerebral edema. If necessary, perform artificial ventilation.

For convulsive syndrome, anticonvulsants are used to combat feverish conditions. During the recovery period, neuroprotectors, nootropics and vitamins are needed. Depending on the degree of dysfunction of the brain, classes with a speech therapist or rehabilitation doctor may be required. In 1-2% of patients, the disease passes without consequences. In other cases, there are persistent residual effects.