Viral Infections of the Nervous System

Romeo Yu Enriquez, M.D.

Angeles University
College of Medicine
Six Viral Syndromes
• 1. Acute anterior poliomyelitis
• 2. Herpes Zoster gangionitis
• 3. Acute aseptic meningitis
• 4. Acute Encephalitis or
meningoencephalitis
• 5. Slow virus infections
• 6. AIDS
Viral Infections of the Nervous System
The Syndrome of Acute Anterior Poliomyelitis

• Etiology:
– poliovirus
– Coxsackie virus A and B
– echoviruses

Viral Infections of the Nervous System

The Syndrome of Acute Anterior Poliomyelitis

• Clinical Features
– fever, malaise, headache, nausea and vomiting
– stiffness and aching muscles
– mild meningeal irritation
– weakness and paralysis of muscles
• flaccid, lower motor neuron type
• asymmetrical

Viral Infections of the Nervous System

The Syndrome of Acute Anterior Poliomyelitis

• Pathology
– destruction of anterior horn cells with
phagocytosis by microglia, gliosis and
perivascular meningeal infiltrates
– Bulbar motor nuclei, dentate nuclei and motor
cortex may also be involved

Viral Infections of the Nervous System

 The Syndrome of Acute Anterior Poliomyelitis

• Treatment:
– Prevention with Oral polio vacine

Table of Contents Viral Infections of the Nervous System

The syndrome of Herpes Zoster
• A.k.a. : Shingles
• 3-5 cases / 100000 / year
• more frequent in elderly and in those with
malignancy
• It probably reprsents reactivation of
varicella infection in sensory ganglia

Viral Infections of the Nervous System

The syndrome of Herpes Zoster
• Clinical Manifestations
– radicular pain
– vesicular cutaneous eruption over two-three
dermatomes( thoracic most frequent)
– sensory impairment of dermatomes involved

Viral Infections of the Nervous System

 The syndrome of Herpes Zoster
• Pathology
– Acyclovir 800 mg 5 times/day
– Prednisome may help reduce Post herpetic
neuralgia
– Carbamazepine, amitryptylline for Post
herpetic neuralgia

Table of Contents Viral Infections of the Nervous System

The Syndrome of Aseptic
Meningitis
• Headache, fever, signs of meningeal
irritation
• lymphocytic pleocytosis with normal
glucose
• photophobia and pain on eye movement
• drowsiness and confusion may be present

Viral Infections of the Nervous System

The Syndrome of Aseptic
Meningitis
• Viral causes
– Enteroviruses (80%)
– Mumps
– Herpes simplex, type 2, and Epstein-Barr virus
– Lymphocytic choriomeningitis
– Adenoviruses
– HIV

Viral Infections of the Nervous System

 The Syndrome of Aseptic
Meningitis
• Nonviral Causes
– Spirochetal infections
– Mycoplasma pneumoniae
– Bacterial infections overlying meninges
– Carinomatous meningitis
– Recurrent inflammatory meningitides

Table of Contents Viral Infections of the Nervous System

The Syndrome of Acute
Encephalitis
• Febrile illness
• syndrome of meningitis
• impairment of consciousness
• focal neurologic deficits
• usually seasonal

Viral Infections of the Nervous System

The Syndrome of Encephalitis
Etiology
– Mumps
– Arboviruses
– Herpes simplex
– Lymphocytic choriomeningitis
– Enteroviruses
– Cytomegalovirus
– Adenoviruses
– Rabies
Viral Infections of the Nervous System
The Syndrome of Encephalitis
• Herpes Simplex
– Sporadic throughout the year
– due to type 2 herpes simplex virus
– fever, headache, confusion, stupor and coma over
several days
– Pathology: lesions in the inferior and medial parts of the
temporal lobes as well as inferior part of frontal lobes
– Lesions: inflammation, pannecrosis, hemorrhage
• intranuclear eosinophilic inclusions in neurons

Viral Infections of the Nervous System

The Syndrome of Encephalitis
• Herpes Simplex
– Diagnosis
• CT and MRI-temporal and frontal lobe lesions
• CSF: mononuclear pleocytosis, elevated protein,
normal glucose and RBCs
• EEG: Periodic high voltage complexes in the teporal
leads and sloe 2-3 per second slow waves

Viral Infections of the Nervous System

The Syndrome of Encephalitis
• Herpes Simplex
– Prognosis: about half do not survive
– Treatment:
• acyclovir
• No steroids
• Supportive

Viral Infections of the Nervous System

 Slow Viruses
Subacute Sclerosing Panencephalitis
• appears in children and adolescents years
after a measles attack
• dementia, focal or generalized seizures, ataxia,
myoclonus
• EEG: periodic complexes
• CSF: elevated gammaglobulin and measles
antibodies
Table of Contents Viral Infections of the Nervous System
 Slow Viruses
Progressive Multifocal Leukoencephalopathy
• Usually associated with Hodgkin’s disease, lymphoma,
chronic leukemia
• 3-6 months development of focal cerebral, brainstem and
cerebellar signs
• Demyelinating lesions
• Inclusion bodies in oligodendroglia and astrocytes
• No treatment

Table of Contents Viral Infections of the Nervous System

 Slow Virus Infections
Subacute spongifrom encephalopathy
• Creutzfeld-Jakob disease
• progressive dementia
• cerebellar ataxia
• heightened startle reaction
• diffuse myoclonic jerks
• CSF is normal
• EEG: Burst suppression
Table of Contents Viral Infections of the Nervous System
 Slow Virus Infections
Subacute spongifrom encephalopathy
• Creutzfeld-Jakob disease
• invariably fatal
• Pathology:
– cerebral and cerebral cortices involved
– diffuse loss of eurons, gliosis, vacuolation of tissues
– no inflammatory changes
• Etology: prions
Table of Contents Viral Infections of the Nervous System
The Acquired Immune Deficiency Syndrome

• Acquired profound depression of cell

mediated immunity
• HTLV
• Opportunistic infections

Viral Infections of the Nervous System

The Acquired Immune Deficiency Syndrome

• Brain:Nonfocal
– AIDs dementia complez
– encephalitis syndromes, CMV, HS
– metabolic encephalopathies
• Spinal cord:
– vacuolar myelopathy
– Herpes simplex or zoster myelitis

Viral Infections of the Nervous System

The Acquired Immune Deficiency Syndrome

• Brain: Focal
– cerebral toxoplasmosis
– PML
– Cryptococcosis
– Varicella-Zoster virus encephalitis
– TB brain abscess or tuberculoma
– Neurosyphillis
– Primary CNS lymphoma
– Vascular disorders
Viral Infections of the Nervous System
 The Acquired Immune Deficiency Syndrome

• Meningitis
– aseptic meningitis
– Cryptococcal meningitis
– TB meningits
– Syphillitic meninigitis
– metastatic lymphomatous meningitis
• Peripheral nerve, roots, muscle and others

Table of Contents Viral Infections of the Nervous System