Skip to main content
SpringerLink
Log in

Cognitive and psychiatric impairment in herpes simplex virus encephalitis suggest involvement of the amygdalo-frontal pathways

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

The long-term neuropsychological and psychiatric sequelae of herpes simplex virus encephalitis (HSVE) and their relationship to the volume of temporal lesions and to amygdala and hippocampus damage remain undefined. We have conducted a prospective study of longterm sequelae in 11 patients with clinically presumed HSVE and detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction. Six months after encephalitis, patients underwent neuropsychological and language assessment. At the same stage, single photon emission computed tomography (SPECT) evaluated the occurrence of hypoperfusion with an index of asymmetry. MRI was used for the measurement of amygdala, hippocampus and cerebral lesions by two blind neurologists. The volume of the amygdala and hippocampus was compared with those of five controls, matched for age and level of education. Longterm memory disorders were seen in 6 patients, associated with the larger lesions and damage of at least two structures. Long-term behavioural changes with emotionalism, irritability, anxiety or depression were prominent in 7. Left prefrontal hypoperfusion appeared in 8 patients, associated with psychiatric disorders in 7 and left amygdala damage in 6. The reduction of amygdala and hippocampus volume was correlated with the overall volume of lesions. Different patterns of mesial temporal lobe damage occurred, involving either amygdala alone, or amygdala and hippocampus, but never hippocampus alone. MRI volumetric measurements in HSVE could be a good indicator of long-term prognosis. Persistant behavioural changes could be related to an amygdala and frontal dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allman P (1991) Emotionalism following brain damage. Behav Neurol 4:57–62

    Google Scholar 

  2. Amaral DG, Price JL (1984) Amygdalo-cortical projections in the monkey (Macaca fascicularis). J Comp Neurol 230:465–496

    PubMed  Google Scholar 

  3. American Psychiatric Association (1987) DSM III-R, Diagnostic and Statistical Manual of Mental Disorders, Revised, 3rd edn. APA, Washington, DC

    Google Scholar 

  4. Aurelius E, Johansson B, Sköldenberg B, Staland A, Forsgren M (1991) Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid. Lancet 337:189–192

    PubMed  Google Scholar 

  5. Bachy N (1989) Exadé: Batterie d'examen de dénomination. Editest, Brussels

    Google Scholar 

  6. Bail L (1994) Segmentation automatique en IRM des lésions de sclérose en plaques. Corrélation avec l'atrophie de corps calleux. Medical thesis, Lille

  7. Bakchine S, Chain F, Lhermitte F (1986) Syndrome de Klüver-Bucy humain complet après une encéphalite à herpès simplex type 2. Rev Neurol (Paris) 42:126–132

    Google Scholar 

  8. Bancaud J, Favel P, Bonis A, Bordas-Ferrer M, Miravet J, Talairach J (1970) Manifestations sexuelles paroxystiques et épilepsie temporale. Etude clinique, EEG et SEEG d'une épilepsie d'origine temporale. Rev Neurol (Paris) 123:217–230

    Google Scholar 

  9. Barbizet J, Duizabo Ph, Poirier J (1978) Etude anatomo-clinique d'un cas d'encéphalite amnésiante d'origine herpétique. Rev Neurol (Paris) 134:241–253

    Google Scholar 

  10. Baxter LR, Schwartz JM, Phelps ME, Mazziota JC (1989) Reduction of prefrontal cortex glucose metabolism common to three types of depression. Arch Gen Psychiatry 46:243–250

    PubMed  Google Scholar 

  11. Benton AL (1968) Differential behavioral effects in frontal lobe disease. Neuropsychologia 6:53–60

    Google Scholar 

  12. Benton AL (1974) The revised visual retention test, 4th edn. Psychological Corporation, New York

    Google Scholar 

  13. Buge A, Chamouard JM, Rancurel G (1988) Le pronostic des encéphalites herpétiques. Etude rétrospective de 19 cas. Presse Méd 17:13–16

    Google Scholar 

  14. Calicis F, Wyns C, Van der Linden M (1995) Epreuve de rappel indicé. Manuel d'utilisation. Adaptation en français d'une épreuve de Grober et Buschke. Faculté de Psychologie UCL, Louvain la neuve (in press)

  15. Caparros-Lefebvre D (1995) Evaluation de logiciels de segmentation et quantification volumétrique en IRM. Corrélations cliniques et neuropsychologiques. PhD thesis, Lille

  16. Caparros-Lefebvre D, Dewilde A, Guffond T, et al (1995) Valeur de l'amplification génique du virus herpétique dans le diagnostic et le traitement des encéphalites aiguës virales. Rev Neurol (Paris) 151:124–128

    Google Scholar 

  17. Cardebat D (1990) Evocation lexicale formelle et sémantique chez des sujets normaux. Acta Neurol Belg 90:207–217

    PubMed  Google Scholar 

  18. Corsi P (1972) Human memory and the medial temporal region of the brain. PhD thesis, McGill University, Montreal

    Google Scholar 

  19. Cuenod CA, Denys A, Michot JL, Jehenson P, Forette F, Kaplan D, Boller F (1993) Amygdala atrophy in Alzheimer's disease. An in vivo magnetic resonance imaging study. Arch Neurol 50:941–945

    PubMed  Google Scholar 

  20. Damasio A, Vanhoesen G (1985) The limbic system and the localisation of herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 48:237–301

    Google Scholar 

  21. Davis M, Hitchcock JM, Rosen JB (1987) Anxiety and the amygdala: pharmacological and anatomical analysis of the fear-potentiated startle paradigm. In: Bowen GH (ed) The psychology of learning and motivation, vol 21. Academic Press, New York, pp 263–305

    Google Scholar 

  22. DeRenzi E, Faglioni P (1978) Nonnative data and screening power of a shortened version of the token test. Cortex 14:41–49

    Google Scholar 

  23. Drachman DA, Arbit J (1966) Memory and the hippocampal complex. Arch Neuro 15:52–61

    Google Scholar 

  24. Dubas F, Pénisson-Besnier I, Pouplard-Barthelaix A, LeGall D, Emile J (1989) Un cas clinico-pathologique d'encéphalite lentement progressive sans nécrose temporale. Rev Neurol (Paris) 145:808–810

    Google Scholar 

  25. Ducame de Ribaucourt B (1975) Test pour l'examen de l'aphasie. Epreuves cliniques. Centre de Psychologie appliquée, Paris

    Google Scholar 

  26. Girard-Buttaz I (1994) Séquelles neuropsychologiques et comportementales de la méningo-encéphalite herpétique. Etude volumétrique IRM et débitmétrique. Medical thesis, Lille

  27. Goodglass H, Kaplan E (1972) The assessment of aphasia and related disorders. Lea and Febiger, Philadelphia

    Google Scholar 

  28. Gordon B, Selnes OA, Hart J, Hanley DF, Whitley RJ (1990) Long-term cognitive sequelae of aciclovir treated herpes simplex encephalitis. Arch Neurol 47:646–647

    PubMed  Google Scholar 

  29. Goward L, Rabbit P (1988) What intelligence tests don't measure? In: Gruneberg MM, Morris PE, Sykes RN (eds) Practical aspects of memory, current research and issues. Wiley, Chichester

    Google Scholar 

  30. Grober E, Buschke H, Crystal MD, Bang MA, Dresner R (1988) Screening for dementia by memory testing. Neurology 38:900–903

    PubMed  Google Scholar 

  31. Guffond T, Dewilde A, Lobert PE, Caparros-Lefebvre D, Hober D, Wattre P (1994) Significance and clinical relevance of the detection of herpes simplex virus DNA by the polymerase chain reaction in cerebrospinal fluid from patients with presumed encephalitis. Clin Infect Dis 18:744–749

    PubMed  Google Scholar 

  32. Halgren E (1992) Emotional neurophysiology of the amygdala within the context of human cognition. In: Aggleton JP (ed) The amygdala: neurobiological aspects of emotion, memory, and mental dysfunction. Wiley-Liss, New York, pp 191–228

    Google Scholar 

  33. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    PubMed  Google Scholar 

  34. Hoffman E, Sung CH, Phelps M (1979) Quantification in positron emission computed tomography, effect of object size. J Comput Assist Tomogr 3:299–308

    PubMed  Google Scholar 

  35. Kapur N, Barker S, Burrows EH, Ellison D, Brice J, Illis LS, Scholey K, Colbourn C, Wilson B, Loates M (1994) Herpes simplex encephalitis: long term magnetic resonance imaging and neuropsychological profile. J Neurol Neurosurg Psychiatry 57:1334–1342

    Google Scholar 

  36. Laurent B, Allegri RF, Michel D, et al (1990) Encéphalites herpétiques à prédominance unilatérale. Etude neuropsychologique an long cours de 9 cas. Rev Neurol (Paris) 146:671–681

    Google Scholar 

  37. Laurent B, Allegri RF, Thomas-Anterion C, Foyatier N, Naegele-Faure B, Pellat J (1991) Long-term neuropsychological follow-up in patients with herpes simplex encephalitis and predominantly left-sided lesions. Behav Neurol 4:211–224

    Google Scholar 

  38. Markowitsch HJ (1984) Can amnesia be caused by damage of a single brain structure? Cortex 20:27–45

    PubMed  Google Scholar 

  39. Marlowe WB, Mancall EL, Thomas JJ (1975) Complete Klüver-Bucy syndrome in man. Cortex 11:53–59

    PubMed  Google Scholar 

  40. Miller GA (1956) The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev 63:81–97

    PubMed  Google Scholar 

  41. Nespoulous JL, Lecours AR, Lafond D, Lemay A, Puel M, Joannette Y, Cot F, Rascol A (1992) Protocole Montréal-Toulouse d'examen linguistique de l'aphasie. Orthoédition, Isbergues

    Google Scholar 

  42. Nieuwenhuys R, Voogd J, Van Huijzen C (1988) The human central nervous system, 3rd edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  43. Poeck K (1969) Pathophysiology of emotional disorders associated with brain damage. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 48, Elsevier Science Publishers, pp 343–366

  44. Rey A (1941) L'examen psychologique dans les cas d'encéphalopathie traumatique. Arch Psychol 28:286–340

    Google Scholar 

  45. Steinling M, Mazingue A, Kassiotis P, Gaudet Y, Fialdes P, Duhamel A, Dubois P, Vergnes R (1988) Le HmPaO Tc comme indicateur du débit sanguin cérébral local: étude quantifiée comparée à la méthode par inhalation au Xénon 133. Ann Radiol 31:229–238

    PubMed  Google Scholar 

  46. Steinling M, Leys D, Amegassi F, Soetart G, Vergnes R (1989) Can Alzheimer and multiinfarct dementia be differentiated using99mTc-HMPAO tomograms? In: Bes A (ed) Circulation cérébrale et vieillissement. Libbey, London, pp 291–293

    Google Scholar 

  47. Thomas P, Vaiva G, Samaille E, Maron M, Alaix C, Steinling M, Goudemand M (1993) Cerebral blood flow in major depression and dysthymia. J Affect Disord 29:235–242

    PubMed  Google Scholar 

  48. Tiihonen J, Kuikka J, Kupila J, Partanen K, Vaino P, Airaksinen J, et al (1994) Increase in cerebral blood flow of right prefrontal cortex in man during orgasm. Neurosci Lett 170:241–243

    PubMed  Google Scholar 

  49. Tranel D, Hyman BT (1990) Neuropsychological correlates of bilateral amygdala damage. Arch Neurol 47:349–355

    PubMed  Google Scholar 

  50. Watson C, Andermann F, Gloor P, Jones-Gotman M, Peters T, Evans A, Olivier A, Melanson D, Leroux G (1992) Anatomical basis of amygdaloid and hippocampal volume measurement by magnetic resonance imaging. Neurology 42:1743–1750

    PubMed  Google Scholar 

  51. Wechsler D (1969) Echelle Clinique de Mémoire. Centre de psychologie appliqué, Paris

    Google Scholar 

  52. Wechsler D (1981) WAIS-R Manual. Psychological Corporation, New York

    Google Scholar 

  53. Weinberger DR, Berman KF, Zee RF (1986) Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. I. Regional cerebral blood flow evidence. Arch Gen Psychiatry 43:114–124

    PubMed  Google Scholar 

  54. Yoneda Y, Mori E, Yamashita H, Yamadori A (1994) MRI volumetry of medial temporal lobe structures in amnesia following herpes simplex encephalitis. Eur Neurol 34:243–252

    PubMed  Google Scholar 

  55. Zola-Morgan S, Squire LR, Amaral DG (1986) Human amnesia and the medial temporal region: enduring memory impairment following a bilateral lesion limited to field CA1 of the hippocampus. J Neurosci 6:2950–2967

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Lille University Hospital, Lille, France

    D. Caparros-Lefebvre, I. Girard-Buttaz, F. Lebert, M. Cabaret & H. Petit

  2. Laboratoire de Mesures Automatiques, Lille University, Lille, France

    S. Reboul

  3. Department of Neurology, Lens Hospital, Lens, France

    A. Verier

  4. Department of Nuclear Medicine, Lille University Hospital, Lille, France

    M. Steinling

  5. Department of Neuroradiology, Lille University Hospital, Lille, France

    J. P. Pruvo

Authors
  1. D. Caparros-Lefebvre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Girard-Buttaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Reboul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Lebert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Cabaret
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Verier
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Steinling
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. P. Pruvo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H. Petit
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Caparros-Lefebvre, D., Girard-Buttaz, I., Reboul, S. et al. Cognitive and psychiatric impairment in herpes simplex virus encephalitis suggest involvement of the amygdalo-frontal pathways. J Neurol 243, 248–256 (1996). https://doi.org/10.1007/BF00868522

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00868522

Key words

Search

Navigation