Document Detail


Encephalitis with thalamic and basal ganglia abnormalities: etiologies, neuroimaging, and potential role of respiratory viruses.
MedLine Citation:
PMID:  23196954     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background. Encephalitis is a severe neurological syndrome with devastating consequences. Despite extensive testing, the etiology often remains unknown. Involvement of the thalamus or basal ganglia (T/BG) occurs in a subset of patients with encephalitis and may be an important etiological clue. In order to improve diagnosis of T/BG patients, we reviewed this subgroup within the California Encephalitis Project (CEP).Methods. Data from T/BG cases enrolled in CEP were retrospectively reviewed. Cases were grouped by etiological classification: infectious, post-infectious, and non-infectious, and stratified by age. Neuroimaging reports were examined and compared between etiologies.Results. T/BG neuroimaging abnormalities were reported in 6% of 3,236 CEP cases. An etiology was found in 76%: 37% infectious, 16% post-infectious, and 23% non-infectious. The most frequently identified infectious agent was respiratory viruses, accounting for 31%, predominantly in children. Other infections more common in the T/BG group included Creutzfeldt-Jakob Disease, arbovirus, and Mycobacterium tuberculosis (MTB). Infectious and post-infectious cases had higher median CSF white blood cell count than non-infectious etiologies. Notably, T/BG neuroimaging characteristics were associated with distinct etiologies. In particular, symmetric hemorrhagic abnormalities involving the thalamus were most frequently found within the respiratory virus group.Conclusions. T/BG involvement in patients with suspected encephalitis was associated with specific etiologies. In addition to agents with established predilection for the T/BG such as MTB and arboviruses, a surprisingly high number of cases were potentially associated with respiratory viruses, especially in children. Neuroimaging abnormalities in such patients can aid clinicians in narrowing the etiological scope and in guiding testing.
Authors:
G C Beattie; C A Glaser; H Sheriff; S Messenger; C P Preas; M Shahkarami; A Venkatesan
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-29
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  -     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Communicable Disease & Emergency Response Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, CA.
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