Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A 53-year-old man with herpes encephalitis showing acceleration of improvement in higher brain function after general anesthesia with sevoflurane: a case report

Naohiko Togashi, M.D.1), Kenichi Kaida, M.D., Ph.D.1), Yu Hongo, M.D., Ph.D.1), Go Ogawa, M.D., Ph.D.1)4), Yukinobu Ishikawa, Ph.D.2)5), Katsuhiko Takeda, M.D., Ph.D.3) and Keiko Kamakura, M.D., Ph.D.1)6)

1)Department of Neurology, National Defense Medical College
2)Department of Rehabilitation, International University of Health and Welfare, Mita Hospital
3)Department of Neurology, International University of Health and Welfare, Mita Hospital
4)Present Address: Department of Neurology, Teikyo University
5)Present Address: Department of Speech and Hearing Sciences, International University of Health and Welfare
6)Present Address: Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology

We experienced a right-handed 53-year-old man who presented with disturbance of consciousness and fever. Herpes simplex encephalitis (HSE) was diagnosed based on the detection of herpes simplex virus DNA in the cerebrospinal fluid. The administration of acyclovir for 42 days improved his consciousness level. Drowsiness, fever and seizures reappeared 20 days after stopping acyclovir treatment (day 67) and he responded well to vidarabine and methylprednisolone pulse therapy. An assessment of aphasia on day 98 revealed transcortical sensory aphasia. Brain MRI showed lesion in the left temporal lobe, bilateral insular cortexes and bilateral frontal lobe. His higher brain dysfunction continued. On day 156, he underwent hip replacement arthroplasty under general anesthesia sevoflurane. His higher brain dysfunction rapidly improved thereafter. We concluded that the accelerated improvement in our patient's higher brain function was related to the protective effect of sevoflurane. Some reports also show the protective effects of sevoflurane in experimental allergic encephalomyelitis by inhibition of T cell activation. These protective and anti-inflammatory effects may explain the accelerated improvement in higher brain function after general anesthesia.
Full Text of this Article in Japanese PDF (3298K)

(CLINICA NEUROL, 54: 743|746, 2014)
key words: herpes simplex encephalitis, transcortical sensory aphasia, higher brain dysfunction, inhalation anesthesia, sevoflurane

(Received: 24-Feb-14)