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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.45 no.1 São Paulo Mar. 1987

http://dx.doi.org/10.1590/S0004-282X1987000100006 

Encefalite herpetica do tronco encefálico: relato de um caso autopsiado com estudo imuno-histoquímico e ao microscópio eletrônico

 

Herpetic brainstem encephalitis: report of a post-mortem case studied electron microscopically and immunohisiochemically

 

 

José Eymard Homem PitellaI; Virgínia Hora Rios LeiteII; Marco Aurélio Lana-PeixotoII; Carlos Eduardo BacchiIII

IProfessor Adjunto - Laboratório de Neuropatologia, Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, Universidade Federal de Minas Gerais
IIProfessor Assistente - Laboratório de Neuropatologia, Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, Universidade Federal de Minas Gerais
IIIProfessor Adjunto do Departamento de Patologia da Faculdade de Medicina da UNESP, Botucatu, SP - Laboratório de Neuropatologia, Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, Universidade Federal de Minas Gerais

 

 


RESUMO

É apresentado um caso autopsiado de encefalite herpética do tronco encefalico. Clinicamente o paciente apresentou de início cefaléia, seguida de ataxia, sonolência e paralisias múltiplas de alguns nervos cranianos, evoluindo para a morte em 8 dias. O exame anatomopatológico do encéfalo mostrou encefalite necrosante em focos múltiplos limitada ao tronco encefálico, mais acentuada na ponte e bulbo. A técnica da imunoperoxidase revelou raras células gliais com imunorreatividade intranuclear para antígeno do herpes. Raras partículas virais com as características morfológicas do herpesvírus foram identificadas nos núcleos de células nervosas em material fixado em formol a 10%. Este caso é o segundo relatado de encefalite herpética do tronco do encéfalo confirmado pelo exame anatomopatológico. Comentam-se as vias de chegada do herpesvírus ao sistema nervoso central e sua posterior disseminação, após período de latência e reativação, para a cavidade oral, região órbito-frontal, lobos temporais e tronco encefálico.


SUMMARY

A post-mortem examined case of herpetic brainstem encephalitis is presented. Clinically, the patient had cephalea followed by ataxia, drowsiness and multiple palsies of some cranial nerves, developing into death in eight days. The pathologic examination of the brain showed necrotizing encephalitis in multiple foci limited to the brainstem, more distinctly in the pons and medula oblongata. The technique of immunoperoxidase revealed rare glial cells with intranuclear immunoreactivity for herpes antigen. Rare viral particles with the morphological characteristics of the herpesvirus were identified in the nuclei of neurons in 10% formol fixed material. This is the second reported case of herpetic brainstem encephalitis confirmed by post-mortem examination. The pathway used by the virus to reach the central nervous system and its posterior dissemination to the oral cavity, the orbitofrontal region and the temporal lobes as well as to the brainstem, after a period of latency and reactivation, are discussed.


 

 

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