Wooseong Jeong, Gil Myeong Seong, Jung-Hwan Oh, Jay Chol Choi, Joong-Goo Kim
{"title":"A case report of critical ischemic stroke in moyamoya-like vasculopathy accompanied by systemic lupus erythematosus.","authors":"Wooseong Jeong, Gil Myeong Seong, Jung-Hwan Oh, Jay Chol Choi, Joong-Goo Kim","doi":"10.47936/encephalitis.2021.00150","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00150","url":null,"abstract":"<p><p>Moyamoya-like vasculopathy (MMV) is a rare, chronic, progressive cerebrovascular disorder characterized by stenosis or occlusion of the terminal portion of the bilateral internal carotid arteries and development of abnormal collateral vessels at the base of the brain. This disorder develops in association with various systemic diseases and conditions, including neurofibromatosis type 1, Down syndrome, thyroid disease, radiation therapy, and autoimmune disease. We report a case of a 51-year-old female patient with low-activity systemic lupus erythematosus (SLE) who had a sudden onset of global aphasia and right hemiplegia. Three months previous, she had been on antiplatelet medication due to a single transient ischemic attack. Brain magnetic resonance imaging demonstrated a massive infarct of the left middle cerebral artery territory. Conventional angiography showed complete occlusion of the left middle cerebral artery with poor development of basal collateral vessels. This case demonstrates that a patient with underlying autoimmune disease such as SLE accompanied by MMV should be considered vulnerable to ischemic stroke.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"2 1","pages":"24-27"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/b5/encephalitis-2021-00150.PMC10295907.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10221434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seondeuk Kim, Seon-Jae Ahn, Han Sang Lee, Woo-Jin Lee, Jangsup Moon, Jin Kyun Park, Kon Chu
{"title":"Direct brain involvement of Takayasu arteritis treated with rituximab and infliximab: a case report.","authors":"Seondeuk Kim, Seon-Jae Ahn, Han Sang Lee, Woo-Jin Lee, Jangsup Moon, Jin Kyun Park, Kon Chu","doi":"10.47936/encephalitis.2021.00108","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00108","url":null,"abstract":"<p><p>Takayasu arteritis (TAK) is a systemic vasculitis involving large arteries. Reports of direct central nervous system (CNS) involvement in TAK are extremely rare in the literature. In addition, treatment for direct involvement has not been reported. Herein, we describe a case of encephalitis in a TAK patient who presented with fever and headache at the first attack, then cognitive impairment at the second attack. The patient improved with rituximab and especially infliximab. These findings indicate the usefulness of rituximab and infliximab to treat the direct CNS manifestations in TAK.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"2 1","pages":"9-13"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/aa/encephalitis-2021-00108.PMC10295906.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10202736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Changes in laboratory mice after observation of deceased conspecifics: a pilot suicidality study in animals.","authors":"Daejong Jeon, Sangwoo Kim, Sang Kun Lee, Kon Chu","doi":"10.47936/encephalitis.2021.00080","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00080","url":null,"abstract":"<p><strong>Purpose: </strong>Suicidality can be a serious feature of psychiatric symptoms in encephalitis. Investigating the psychiatric behavior associated with suicidality in animal models of encephalitis is important; thus, determining whether normal laboratory animals are aware of death is necessary.</p><p><strong>Methods: </strong>To examine the behavioral and brain activity changes associated with death of conspecifics, laboratory mice were exposed to a cadaveric mouse or an anesthetized mouse. Behavioral tasks associated with anxiety and locomotion were conducted after repeated exposure. Neural activity in the medial prefrontal cortex during the cadaver exploration was investigated using electroencephalographic recordings.</p><p><strong>Results: </strong>During repeated exposure, mice in the cadaver group showed a gradual decrease in time exploring the cadaver, which was not observed in mice in the anesthesia group. The cadaver group also exhibited increased levels of anxiety in the light/dark transition and elevated plus maze tasks and displayed increased locomotor activity in the open field test. In an electrophysiological study, different brain oscillations were observed when mice were exposed to a cadaveric mouse and an anesthetized mouse. Enhanced delta-band activity and reduced theta- and alpha-band activities were observed during cadaver exploration.</p><p><strong>Conclusion: </strong>The present study results showed that experiences involving dead conspecifics strongly affect mouse behavior and brain activity. These findings may be helpful in treating patients with psychiatric symptoms and aid in understanding the concept of death recognition/awareness in laboratory animals.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"1 4","pages":"103-110"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/d3/encephalitis-2021-00080.PMC10295892.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Progressive multifocal leukoencephalopathy successfully treated with mefloquine and literature review.","authors":"Sungjoon Yoon, Yongmoo Kim, Seon-Jae Ahn, Kon Chu","doi":"10.47936/encephalitis.2021.00094","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00094","url":null,"abstract":"<p><p>Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection due to reactivation of John Cunningham virus (JCV). The diagnosis depends on evidence from clinical, imaging, and virologic studies. When the cerebrospinal fluid shows a negative polymerase chain reaction result, brain biopsy is required to confirm the diagnosis. PML has no standard treatment except for immune reconstitution. The anti-JCV effect of mefloquine, however, is supported by some studies, and if brain biopsy is difficult, a mefloquine trial can be considered. We describe a case of possible PML successfully treated with mefloquine.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"1 4","pages":"111-119"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/2d/encephalitis-2021-00094.PMC10295895.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of inflammasomes in neuroinflammation after ischemic stroke.","authors":"Keun-Hwa Jung, Seung-Yong Seong","doi":"10.47936/encephalitis.2021.00073","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00073","url":null,"abstract":"<p><p>Ischemic stroke is a devastating disease for which there is no effective medical treatment. In the era of extensive reperfusion strategies, established neuroprotectant candidates and novel therapeutic drugs with better targets are promising for treatment of acute ischemic stroke. Such targets include the inflammasome pathway, which contributes significantly to the pathogenesis of ischemic stroke. Following ischemic stroke, damage-associated molecular patterns from damaged cells activate inflammasomes, incur inflammatory responses, and induce cell death. Therefore, inhibiting inflammasome pathways has great promise for treatment of ischemic stroke. However, the efficacy and safety of inflammasome inhibitors remain controversial, and better upstream targets are needed for effective modulation. Herein, the roles of the inflammasome in ischemic injury caused by stroke are reviewed and the potential of neuroprotectants targeting the inflammasome is discussed.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"1 4","pages":"89-97"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/19/encephalitis-2021-00073.PMC10295893.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"COVID-19 and encephalitis.","authors":"Young-Soo Kim","doi":"10.47936/encephalitis.2021.00122","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00122","url":null,"abstract":"<p><p>The current coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2. Due to the increasing number of confirmed cases and accumulating clinical data, in addition to the predominant respiratory symptoms, a significant proportion of patients with COVID-19 experience neurological complications. Presumedly, several mechanisms, such as direct viral effects on the brain parenchyma and endothelium, and activation of the inflammatory and thrombotic pathways, cause these neurological disorders. Herein, the literature focusing on encephalitis among the central nervous system disorders associated with COVID-19 was reviewed.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"1 4","pages":"98-102"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/bf/encephalitis-2021-00122.PMC10295891.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute brainstem encephalitis associated with <i>Mycoplasma pneumoniae</i> in an adult: a case report.","authors":"Min-Hee Woo, Jung-Won Shin","doi":"10.47936/encephalitis.2021.00101","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00101","url":null,"abstract":"<p><p>Brainstem encephalitis (BE) associated with <i>Mycoplasma pneumoniae</i> in adults is rare, and the diagnosis is challenging. We describe an uncommon case of BE in an immunocompetent patient. A 43-year-old, otherwise healthy woman visited our emergency department with high fever and a sore throat, and 3 days later she returned with an altered drowsy mental status. Magnetic resonance imaging displayed diffuse swelling in bilateral cerebral regions involving the bilateral pons. The sera tested positive for the immunoglobulin (Ig) M antibody against <i>M. Pneumoniae</i> as detected by an enzyme immunoassay (EIA), and on hospital day 10, the level of IgM index against <i>M. pneumoniae</i> further increased from 1.5 to 2.1. We changed the antibiotic regimen from vancomycin and ceftriaxone to clarithromycin based on detection of <i>M. pneumoniae</i>, and we added intravenous immunoglobulin. After one month, the patient fully recovered from the neurological deficits. A follow-up brain magnetic resonance imaging was performed, which showed completely resolved lesions. Particle agglutination assay (PA) and EIA are both largely used to diagnose <i>M. pneumoniae</i>. Compared to the PA test, the EIA test could be a reliable tool because it separately measures IgM and IgG antibodies. We diagnosed BE associated with <i>M. pneumoniae</i> through EIA with an increasing level of IgM in the acute and subacute paired sera. Early treatment with macrolide antibiotics resulted in a good outcome.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"1 4","pages":"120-123"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/60/28/encephalitis-2021-00101.PMC10295894.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Low-dose interleukin-2 as a novel therapeutic option for refractory paraneoplastic neurologic syndrome: a case of chronic relapsing anti-Ma2/Ta paraneoplastic myeloradiculopathy.","authors":"Seon-Jae Ahn, Han-Sang Lee, Woo-Jin Lee, Kon Chu","doi":"10.47936/encephalitis.2021.00038","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00038","url":null,"abstract":"<p><p>Paraneoplastic neurologic syndromes (PNS) caused by anti-Ma2/Ta antibodies have diverse presentations. Myeloradiculopathy is one anti-Ma2/Ta-associated PNS manifestation. We report the case of a patient with chronic relapsing anti-Ma2/Ta paraneoplastic myeloradiculopathy. The patient was successfully treated with low-dose human recombinant interleukin-2, despite having chronic relapsing symptoms and a refractory response to conventional immunotherapy.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"1 3","pages":"79-84"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bd/f1/encephalitis-2021-00038.PMC10295880.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yoonhyuk Jang, SeonDeuk Kim, Kon Chu, Sang Kun Lee, Soon-Tae Lee
{"title":"Paraneoplastic encephalitis associated with renal cell carcinoma.","authors":"Yoonhyuk Jang, SeonDeuk Kim, Kon Chu, Sang Kun Lee, Soon-Tae Lee","doi":"10.47936/encephalitis.2021.00059","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00059","url":null,"abstract":"<p><strong>Purpose: </strong>Paraneoplastic encephalitis is autoimmune encephalitis accompanied by tumors. Renal cell carcinoma (RCC) is a kidney cancer originating from various types of renal cells and rarely has been associated with paraneoplastic neurologic manifestation. We identified a case series of paraneoplastic encephalitis-associated RCC.</p><p><strong>Methods: </strong>From a prospective institutional cohort, we identified autoimmune encephalitis patients with RCC. The association between RCC and encephalitis was determined by the following criteria: (1) possible autoimmune encephalitis according to the operational autoimmune encephalitis diagnostic criteria and (2) RCC simultaneously diagnosed with neurological manifestation of encephalitis.</p><p><strong>Results: </strong>A total of three patients presented encephalitis accompanied by RCC. Two patients had clear cell RCC, and one had chromophobe RCC. All patients showed limbic encephalitis with cognitive decline, memory impairment, or seizure. Brain magnetic resonance imaging showed T2 hyperintensities at the mesial temporal lobe in two patients with clear cell RCC but no remarkable findings in one patient with chromophobe RCC. While one patient who had early surgery within one month of RCC onset had a favorable response to the treatment, the other two patients showed a partial response and a detrimental result.</p><p><strong>Conclusion: </strong>Paraneoplastic encephalitis associated with RCC presented as limbic encephalitis and was responsive to immunotherapy combined with tumor resection. As our cases identified, RCC should be considered as a cause of seronegative autoimmune encephalitis.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"1 3","pages":"73-78"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/a1/encephalitis-2021-00059.PMC10295882.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Epstein-Barr virus-associated acute disseminated encephalomyelitis successfully treated with rituximab: a case report.","authors":"Seoyeon Kim, Seon-Jae Ahn, Kon Chu","doi":"10.47936/encephalitis.2021.00066","DOIUrl":"https://doi.org/10.47936/encephalitis.2021.00066","url":null,"abstract":"<p><p>Acute disseminated encephalomyelitis (ADEM) is a monophasic central nervous system inflammatory demyelinating disorder clinically defined by multifocal neurologic symptoms with encephalopathy. Brain magnetic resonance imaging most often reveals multiple T2 hyperintense lesions consistent with demyelination. High-dose corticosteroids are the current treatment of choice, and intravenous immunoglobulin or plasmapheresis is considered in steroid-unresponsive cases. The majority of patients show favorable outcomes with full clinical recovery and complete or partial resolution of previous lesions. For patients who are refractory to multiple immunomodulatory agents, other treatments such as rituximab have been used. We present a patient who developed ADEM after Epstein-Barr virus infection who achieved full recovery with immunotherapy including rituximab.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"1 3","pages":"85-88"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/b4/encephalitis-2021-00066.PMC10295881.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}