Postencephalitic amnesia with long term-working memory impairment: A case report

Baldivia, Beatriz; Saa, Pablo Resende; Rocha, Maria Sheila Guimarães; Brucki, Sonia Maria Dozzi

doi:10.1590/S1980-57642009DN20400022

Abstract

Herpes simplex virus encephalitis (HSVE) is an inflammation of the brain parenchyma caused by virus, leading to focal necrosis in medial temporal lobes, hippocampal complex and basal forebrain. Cognitively, HSVE is associated to many dysfunctions which vary according to the extent of the lesion. Episodic memory impairment is the most common sequelae following HSVE episodes, although others can occur. The aim of this case report was to describe the cognitive profile of a 42 year-old man who had extensive bilateral damage to the medial temporal lobe, insular bilateral and orbitofrontal cortices due to HSVE. Severe anterograde and retrograde amnesia, naming deficits, perseverative behaviors and confabulations were observed on neuropsychological assessment. We discussed the concept of long term-working memory based on this evaluation. These cognitive impairments corroborated HSVE previous findings in the literature.

Key words:
encephalitis; episodic memory impairment; naming deficit; confabulation

Resumo

Encefalite herpética (EH) é uma inflamação do parênquima cerebral causada pelo vírus herpes e associada à necrose focal nos lobos temporais mesiais, formação hipocampal e nas partes basais do córtex pré-frontal. Cognitivamente, a EH é relacionada a diversos prejuízos que variam de acordo com a extensão da lesão. Prejuízo na memória episódica é a seqüela mais freqüente, embora outros possam ocorrer. O objetivo deste relato de caso é descrever o perfil cognitivo de um homem de 42 anos que teve extensa lesão nos lobos temporais mesiais, nas ínsulas e nas regiões orbitofrontais em decorrência de um episódio de EH. Amnésias do tipo anterógrada e retrógrada, prejuízos na nomeação, comportamentos perseverativos e confabulações foram observadas pela avaliação neuropsicológica. Nós discutimos o conceito de memória operacional de longo prazo com vistas aos resultados obtidos. Os prejuízos cognitivos observados corroboram a literatura sobre EH.

Palavras-chave:
encefalite herpética; déficit de memória episódica; prejuízo de nomeação; confabulação

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References

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Mendez M F, Cummings JL. Dementia from conventional infectious agents. In: Mendez MF, Cummings JL, editors. Dementia: A clinical approach, Philadelphia: Butterworth Heineman; 2003;339-385.
²
Tulving E. Episodic and semantic memory. In: E Tulving, W Donaldson, editors. Organization of memory. New York: Scedmic Press; 1972:382-404.
³
Hokkanen L, Lunes J. Cognitive outcome in acute sporadic encephalitis. Neuropsychol Rev 2000;10:151-167.
⁴
Kennedy PG, Chaudhuri A. Herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 2002;73:237-238.
⁵
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003; 61:777-781.
⁶
Dubois B, Slachevsky A, Litvan I, Pillon B.The FAB. A frontal assessment battery at bedside. Neurology 2000;55:1621-1626.
⁷
Jorm AF, Jacomb PA. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med 1989;19:1015-1022.
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Wright, J. The Disability Rating Scale. The Center for Outcome Measurement in Brain Injury. 2000. http://www.tbims.org/combi/drs ( accessed August 8, 2008 )
» http://www.tbims.org/combi/drs
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Wechsler D. WMS-R. Wechsler memory scale-revised manual. San Antonio: Psychological Corporation; 1987.
¹⁰
Wechsler D. Escala de Inteligência Wechsler para adultos- 3ª edição. Adaptação brasileira - 1ª edição de Nascimento, E. Casa do Psicólogo, 2004.
¹¹
Kapur N, Barker S, Burrows EH. Herpes simplex encephalitis: long term magnetic resonance imaging and neuropsychological profile. J Neurol Neurosurg Psychiatry 1994; 57:1334-1342.
¹²
Tanaka Y, Miyazawa Y, Hashimoto R, Nakano I, Obayashi T. Postencephalitic focal retrograde amnesia alter bilateral anterior temporal lobe damage. Neurology 1999;53:344-350.
¹³
Markowitsch HJ. Which brain regions are critically involved in the retrieval of old episodic memory? Brain Res Rev 1995;21: 117-127.
¹⁴
Baddeley AD, Warrington EK. Amnesia and the distinction between long and short-term memory. J Verb Learn Verb Behav 1970;9:176-189.
¹⁵
Scoville WB, Milner B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry 1957; 20:11-21.
¹⁶
Ericson KA, Kintsch W. Long Term Working Memory. Psychol Rev 1995;102:211-245.
¹⁷
Del Grosso Destreri N, Farina E, Calabrese E, Pinard G, Imbornone E, Mariani C. Frontal impairment and confabulation after herpes simplex encephalitis: a case report. Arch Phys Med Rehabil 2002;83:423-426.
¹⁸
Mattioli F, Miozzo A, Vignolo LA. Confabulation and delusional misidentification: a four year follow-up study. Cortex 1999;35:413-422.
¹⁹
Kern RS, Van Gorp WG, Cummings JL, Brown WS, Osato SS. Confabulation in Alzheimer's disease. Brain Cog 1992;19: 172-182.
²⁰
Fischer RS, Alexander MP, D'esposito M, Otto R. Neuropsychological and neuroanatomical correlates of confabulation. J Clin Exp Neuropsychol 1995;17:20-28.
²¹
Cunningham JM, Pliskin NH, Cassisi JE, Tsang B, Rao SM. Relationship between confabulation and measures of memory and executive function. J Clin Exp Neuropsychol 1997;19:867-877.
²²
Turner MS, Cipolotti L, Yousry TA, Shallice T. Confabulation: Damage to a specific inferior medial prefrontal system.Cortex 2008;44:637-648.
²³
Gilboa A, Alain C, Stuss DT, Melo B, Miller S, Moscovitch M. Mechanisms of spontaneous confabulations: a strategic retrieval account. Brain 2006;129:1399-1414.
²⁴
Garrard P, Perry R, Hodges JR. Disorders of semantic memory. J Neurol Neurosurg Psychiatry 1997;62:431-435.
²⁵
Miceli G, Amitrano A, Capasso R, Caramazza A. The treatment of anomia resulting from output lexical damage: analysis of the improvement made in word retrieval skills. Cortex 1973;9:411-418.
²⁶
Miotto EC. Cognitive rehabilitation of naming deficits following viral meningo-encephalitis. Arq Neuropsiquiatr 2002;60:21-27.
²⁷
Alvarez J A, Emory E. Executive function and the frontal lobe: A meta-analytic review. Neuropsychol Rev 2006;16:17-42.
²⁸
Warren JD, Warren JE, Fox NC, Warrington EK. Nothing to say, something to sing: primary progressive dynamic aphasia. Neurocase 2003;9:140-155.
²⁹
Struss DT, Knight R. Principles of frontal lobe function. New York: Oxford University Press; 2002.
³⁰
Gilboa A, Moscovitch M. The cognitive neuroscience of confabulation: A review and a model. In: Baddeley AD, Kopelman MD, Wilson BA. Handbook of Memory Disorders, 2nd ed. London: Wiley; 2002:315-342.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
16 Oct 2008
Accepted
16 Nov 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Mendez M F, Cummings JL. Dementia from conventional infectious agents. In: Mendez MF, Cummings JL, editors. Dementia: A clinical approach, Philadelphia: Butterworth Heineman; 2003;339-385.

[2] ²
Tulving E. Episodic and semantic memory. In: E Tulving, W Donaldson, editors. Organization of memory. New York: Scedmic Press; 1972:382-404.

[3] ³
Hokkanen L, Lunes J. Cognitive outcome in acute sporadic encephalitis. Neuropsychol Rev 2000;10:151-167.

[4] ⁴
Kennedy PG, Chaudhuri A. Herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 2002;73:237-238.

[5] ⁵
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003; 61:777-781.

[6] ⁶
Dubois B, Slachevsky A, Litvan I, Pillon B.The FAB. A frontal assessment battery at bedside. Neurology 2000;55:1621-1626.

[7] ⁷
Jorm AF, Jacomb PA. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med 1989;19:1015-1022.

[8] ⁸
Wright, J. The Disability Rating Scale. The Center for Outcome Measurement in Brain Injury. 2000. http://www.tbims.org/combi/drs ( accessed August 8, 2008 )
» http://www.tbims.org/combi/drs

[9] ⁹
Wechsler D. WMS-R. Wechsler memory scale-revised manual. San Antonio: Psychological Corporation; 1987.

[10] ¹⁰
Wechsler D. Escala de Inteligência Wechsler para adultos- 3ª edição. Adaptação brasileira - 1ª edição de Nascimento, E. Casa do Psicólogo, 2004.

[11] ¹¹
Kapur N, Barker S, Burrows EH. Herpes simplex encephalitis: long term magnetic resonance imaging and neuropsychological profile. J Neurol Neurosurg Psychiatry 1994; 57:1334-1342.

[12] ¹²
Tanaka Y, Miyazawa Y, Hashimoto R, Nakano I, Obayashi T. Postencephalitic focal retrograde amnesia alter bilateral anterior temporal lobe damage. Neurology 1999;53:344-350.

[13] ¹³
Markowitsch HJ. Which brain regions are critically involved in the retrieval of old episodic memory? Brain Res Rev 1995;21: 117-127.

[14] ¹⁴
Baddeley AD, Warrington EK. Amnesia and the distinction between long and short-term memory. J Verb Learn Verb Behav 1970;9:176-189.

[15] ¹⁵
Scoville WB, Milner B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry 1957; 20:11-21.

[16] ¹⁶
Ericson KA, Kintsch W. Long Term Working Memory. Psychol Rev 1995;102:211-245.

[17] ¹⁷
Del Grosso Destreri N, Farina E, Calabrese E, Pinard G, Imbornone E, Mariani C. Frontal impairment and confabulation after herpes simplex encephalitis: a case report. Arch Phys Med Rehabil 2002;83:423-426.

[18] ¹⁸
Mattioli F, Miozzo A, Vignolo LA. Confabulation and delusional misidentification: a four year follow-up study. Cortex 1999;35:413-422.

[19] ¹⁹
Kern RS, Van Gorp WG, Cummings JL, Brown WS, Osato SS. Confabulation in Alzheimer's disease. Brain Cog 1992;19: 172-182.

[20] ²⁰
Fischer RS, Alexander MP, D'esposito M, Otto R. Neuropsychological and neuroanatomical correlates of confabulation. J Clin Exp Neuropsychol 1995;17:20-28.

[21] ²¹
Cunningham JM, Pliskin NH, Cassisi JE, Tsang B, Rao SM. Relationship between confabulation and measures of memory and executive function. J Clin Exp Neuropsychol 1997;19:867-877.

[22] ²²
Turner MS, Cipolotti L, Yousry TA, Shallice T. Confabulation: Damage to a specific inferior medial prefrontal system.Cortex 2008;44:637-648.

[23] ²³
Gilboa A, Alain C, Stuss DT, Melo B, Miller S, Moscovitch M. Mechanisms of spontaneous confabulations: a strategic retrieval account. Brain 2006;129:1399-1414.

[24] ²⁴
Garrard P, Perry R, Hodges JR. Disorders of semantic memory. J Neurol Neurosurg Psychiatry 1997;62:431-435.

[25] ²⁵
Miceli G, Amitrano A, Capasso R, Caramazza A. The treatment of anomia resulting from output lexical damage: analysis of the improvement made in word retrieval skills. Cortex 1973;9:411-418.

[26] ²⁶
Miotto EC. Cognitive rehabilitation of naming deficits following viral meningo-encephalitis. Arq Neuropsiquiatr 2002;60:21-27.

[27] ²⁷
Alvarez J A, Emory E. Executive function and the frontal lobe: A meta-analytic review. Neuropsychol Rev 2006;16:17-42.

[28] ²⁸
Warren JD, Warren JE, Fox NC, Warrington EK. Nothing to say, something to sing: primary progressive dynamic aphasia. Neurocase 2003;9:140-155.

[29] ²⁹
Struss DT, Knight R. Principles of frontal lobe function. New York: Oxford University Press; 2002.

[30] ³⁰
Gilboa A, Moscovitch M. The cognitive neuroscience of confabulation: A review and a model. In: Baddeley AD, Kopelman MD, Wilson BA. Handbook of Memory Disorders, 2nd ed. London: Wiley; 2002:315-342.

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