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Zhihua Si,1,* Lin Li,2,* Jingzhe Han1 1Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, People’s Republic of China; 2Department of Pain, Harrison International Peace Hospital, Hengshui, Hebei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingzhe Han, Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, 053000, People’s Republic of China, Tel/Fax +86-318-2187209, Email hanjingzhe2017@sina.comBackground: Metagenomic next-generation sequencing (mNGS) is becoming increasingly extensive in diagnosing herpes simplex encephalitis (HSE). However, many HSE patients with normal cerebrospinal fluid (CSF) diagnosed by mNGS have been found during the clinical application. This study aimed to summarize and analyze the clinical characteristics, supplementary examinations, and prognosis of patients with HSE whose cerebrospinal fluid was confirmed to be normal by mNGS.Methods: This retrospective study evaluated the clinical characteristics, auxiliary examinations, and patient prognosis of patients with HSE that were diagnosed by mNGS but had normal CSF. Clinical data collected included baseline information, signs and symptoms upon admission, and risk factors for infection. Auxiliary examinations included indirect immunofluorescence assay (IIF), cell-based assay (CBA), and CSF testing. Prognosis was evaluated based on hospital stay and patient survival.Results: Seven of the nine patients (77.8%) experienced headaches, and four (44.4%) had a fever of 38°C or higher. The average leukocyte count in the CSF was 2.6 ± 2.3/L. According to the mNGS, the median sequence count of HSV was 2 (1, 16). Magnetic resonance imaging (MRI) revealed one bilateral temporal lobe lesion (11.1%), two isolated bilateral frontal lobe lesions (22.2%), and one bilateral cingulate gyrus lesion (11.1%). One patient (11.1%) was admitted to the intensive care unit and passed away in the hospital. The remaining patients (88.9%) had a positive prognosis upon discharge.Conclusion: Patients with HSE who had normal CSF were typically middle-aged women with normal immune function. They showed typical HSE clinical features, such as fever, headache and epilepsy, that did not differ from those of other HSE patients. A normal CSF result is generally associated with a low viral load and the body’s ability to mount an effective immune response. Most of these patients have a favorable prognosis.Keywords: herpes simplex encephalitis, herpes simplex virus, cerebrospinal fluid, metagenomic next-generation sequencing, atypical clinical manifestations

Supplemental material, sj-pdf-1-imr-10.1177_03000605231179817 for Delayed gadolinium contrast-enhanced 3D-T1 SPACE STIR sequence can better visualize abnormal cranial nerves: a case report by Lu Zhang, Zhilei Kang, Mingyue Hu and Jingzhe Han in Journal of International Medical Research

Neuromyelitis optica spectrum disease (NMOSD) is a debilitating autoimmune inflammatory demyelinating disease of the central nervous system. The relationship between harboring an infection and NMOSD is currently unclear and needs further investigation. This article reports meningoencephalitis-like manifestations, including fever, headache, neck resistance, seizures, and pleocytosis, accompanied by nausea and vomiting, in a patient with serum AQP4 antibody-positive area postrema syndrome (APS). In the presence of aseptic meningitis combined with clinical symptoms such as optic neuritis and myelitis, the possibility of NMOSD diagnosis can be considered. However, for patients with unknown causes, especially combined with aseptic meningitis, a probable differential diagnosis of NMOSD is considered.

Supplementary Material 1

NLSDM is a rare metabolic myopathy caused by mutations in the patatin-like phosphatase domain protein 2 (PAPLA2) genes. In the present study, we describe the clinical and genetic findings in our Chinese patient with NLSDM. Sequence analysis of PNPLA2 gene was performed. Gene analysis for PNPLA2 revealed an identical homozygous mutation c.757+1G>T in our patient. The clinical symptoms of our patient are related to the type of mutation in the PNPLA2 gene and environmental effects.

This article reported a case of a third ventricle tumor with Bruns syndrome sudden disturbance of consciousness as the first manifestation, to improve the clinician’s understanding and awareness of the fatal signs. A 38-year-old healthy man was admitted to our hospital for a sudden onset coma for 2 hours. Head magnetic resonance imaging (MRI) showed midbrain aqueduct occlusion, intraductal abnormal nodule signal, considering space-occupying lesions. On the fourth day of admission, the patient was scheduled to undergo ventriculoscopic resection of the mass, but the patient had a small ventricular foramen, which was difficult to explore the posterior part of the third ventricle, and the possibility of injuring the vein was high. Finally, the third ventriculostomy was performed by ventriculoscope. 6 months later, the tumor grew slowly and the patient had no hydrocephalus.

Rationale: Subarachnoid hemorrhage (SAH) is a common and serious disease and one of the most important differential diagnoses in the emergency department. Patient concerns: A 39-year-old female patient with a 12 years’ history of migraine, presented with a sudden headache combined with motor aphasia. Physical examination suggested probable positive neck resistance. SAH was confirmed by magnetic resonance imaging. In addition, spinal digital subtraction angiography and spinal vascular computed tomography angiography indicated spinal arteriovenous malformation (SAVM). Diagnoses: The final diagnosis was spinal dural arteriovenous fistula presenting with SAH. Interventions: Following diagnosis, appropriate drugs were administered, but the therapeutic effect was poor. Then the patient was then transferred to a superior hospital where she was treated with interventional embolization. Outcomes: Through 2 years of follow-up, intermittent migraine was found in the patient, but the symptoms of occipital pain, nausea, and vomiting did not occur again. Lessons: For patients who have been diagnosed with SAH but have no definite cause, we should pay attention to the etiological screening of SAH, and the possibility of the spinal cord SAH should be vigilant. The pain in the chest and back and the signs of spinal cord may be an important breakthrough in patients with spinal cord SAH, and medical history and physical examination are particularly important.