Skip to main content

Advertisement

Springer Nature Link
Log in

Viral encephalitis: Neuropsychiatric and neurobehavioral aspects

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Viral encephalitis, a condition in which a virus infects the brain and produces an inflammatory response, affects approximately 20,000 individuals per year in the United States. The viral encephalidities include sporadic and epidemic acute viral encephalidities and subacute and chronic/progressive viral encephalitis or encephalomyelitis. In people who survive these conditions, postencephalitic impairments of elemental neurologic, cognitive, emotional, and behavioral function are common. This article will provide a brief overview of the diagnosis and acute management of acute viral infections of the central nervous system. The neurologic and neuropsychiatric features, neuropathologies, and treatments of two of the more common types of acute viral encephalitis in North America— herpes simplex encephalitis and West Nile encephalitis—will be reviewed. The current and future role of psychiatrists and neuropsychiatrists in the care and study of individuals with these conditions will be discussed.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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 and Recommended Reading

  1. Mendez MF, Cummings JL: Dementia from conventional infectious agents. In Dementia. A Clinical Approach. Edited by Mendez MF, Cummings JL. Philadelphia: Butterworth Heineman; 2003:339–385. An excellent review of the neurobehavioral features of viral encephalidities, including epidemic and sporadic, acute and subacute, and chronic and progressive.

    Google Scholar 

  2. Hinson VK, Tyor WR: Update on viral encephalitis. Curr Opin Neurol 2001, 14:369–374.

    Article  PubMed  CAS  Google Scholar 

  3. Davison KL, Crowcroft NS, Ramsay ME, et al.: Viral encephalitis in England, 1989–1998: what did we miss? Emerg Infect Dis 2003, 9:234–240.

    PubMed  Google Scholar 

  4. Moore DP: Infectious disorders. In Textbook of Clinical Neuropsychiatry. Edited by Moore DP. London: Arnold; 2001:527–565.

    Google Scholar 

  5. Anderson CA, Gilden D: Viral meningitis and encephalitis. In Conn’s Current Therapy. Edited by Rakel R. Philadelphia: WB Saunders; 1996:878–881.

    Google Scholar 

  6. Rotbart HA: Viral meningitis. Semin Neurol 2000, 20:277–292.

    Article  PubMed  CAS  Google Scholar 

  7. Sivertsen B, Christensen PB: Acute encephalitis. Acta Neurol Scand 1996, 93:156–159.

    Article  PubMed  CAS  Google Scholar 

  8. Arias E, Anderson RN, Kung H-C, et al.: Deaths: Final data for 2001. Natl Vital Stat Rep 2003, 52:1–116.

    PubMed  Google Scholar 

  9. Malkin JE: Epidemiology of genital herpes simplex virus infection in developed countries. Herpes 2004, 11(Suppl 1):2A-23A.

    PubMed  Google Scholar 

  10. Skoldenberg B: Herpes simplex encephalitis. Scand J Infect Dis Suppl 1996, 100:8–13.

    PubMed  CAS  Google Scholar 

  11. Koskiniemi M, Piiparinen H, Mannonen L, et al.: Herpes encephalitis is a disease of middle aged and elderly people: polymerase chain reaction for detection of herpes simplex virus in the CSF of 516 patients with encephalitis. The Study Group. J Neurol Neurosurg Psychiatry 1996, 60:174–178.

    PubMed  CAS  Google Scholar 

  12. Thajeb P, Huang KM, Shih CC: Diaschisis in chronic viral encephalitis with Koshevnikov syndrome. J Neuroimaging 1999, 9:122–125.

    PubMed  CAS  Google Scholar 

  13. Sage JI, Weinstein MP, Miller DC: Chronic encephalitis possibly due to herpes simplex virus: two cases. Neurology 1985, 35:1470–1472.

    PubMed  CAS  Google Scholar 

  14. Hokkanen L, Poutiainen E, Valanne L, et al.: Cognitive impairment after acute encephalitis: comparison of herpes simplex and other aetiologies. J Neurol Neurosurg Psychiatry 1996, 61:478–484. This article is a clear and concise description of the cognitive profile associated with herpes encephalitis.

    PubMed  CAS  Google Scholar 

  15. Hokkanen L, Salonen O, Launes J: Amnesia in acute herpetic and nonherpetic encephalitis. Arch Neurol 1996, 53:972–978.

    PubMed  CAS  Google Scholar 

  16. Utley TF, Ogden JA, Gibb A, et al.: The long-term neuropsychological outcome of herpes simplex encephalitis in a series of unselected survivors. Neuropsychiatry Neuropsychol Behav Neurol 1997, 10:180–189.

    PubMed  CAS  Google Scholar 

  17. De Renzi E, Lucchelli F: Are semantic systems separately represented in the brain? The case of living category impairment. Cortex 1994, 30:3–25.

    PubMed  Google Scholar 

  18. Kaga K, Kaga M, Tamai F, Shindo M: Auditory agnosia in children after herpes encephalitis. Acta Otolaryngol 2003, 123:232–235.

    Article  PubMed  Google Scholar 

  19. McGrath N, Anderson NE, Croxson MC, Powell KF: Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry 1997, 63:321–326.

    PubMed  CAS  Google Scholar 

  20. Laurent B, Allegri RF, Michel D, et al.: [Primarily unilateral herpes encephalitis. Long-term neuropsychological study of 9 cases]. Rev Neurol (Paris) 1990, 146:671–681.

    CAS  Google Scholar 

  21. Greer MK, Lyons-Crews M, Mauldin LB, Brown III FR: A case study of the cognitive and behavioral deficits of temporal lobe damage in herpes simplex encephalitis. J Autism Dev Disord 1989, 19:317–326.

    Article  PubMed  CAS  Google Scholar 

  22. Hart RP, Kwentus JA, Frazier RB, Hormel TL: Natural history of Kluver-Bucy syndrome after treated herpes encephalitis. South Med J 1986, 79:1376–1378.

    Article  PubMed  CAS  Google Scholar 

  23. Nakada T, Lee H, Kwee IL, Lerner AM: Epileptic Kluver-Bucy syndrome: case report. J Clin Psychiatry 1984, 45:87–88.

    PubMed  CAS  Google Scholar 

  24. Lilly R, Cummings JL, Benson DF, Frankel M: The human Kluver-Bucy syndrome. Neurology 1983, 33:1141–1145.

    PubMed  CAS  Google Scholar 

  25. Raskin DE, Frank SW: Herpes encephalitis with catatonic stupor. Arch Gen Psychiatry 1974, 31:544–546.

    PubMed  CAS  Google Scholar 

  26. Adams JH, Miller D: Herpes simplex encephalitis: a clinical and pathological analysis of twenty-two cases. Postgrad Med 1973, 49:393–397.

    Article  Google Scholar 

  27. Steiner I, Mador N, Reibstein I, et al.: Herpes simplex virus type 1 gene expression and reactivation of latent infection in the central nervous system. Neuropathol Appl Neurobiol 1994, 20:253–260.

    PubMed  CAS  Google Scholar 

  28. Lester JW, Jr., Carter MP, Reynolds TL: Herpes encephalitis: MR monitoring of response to acyclovir therapy. J Comput Assist Tomogr 1988, 12:941–943.

    Article  PubMed  Google Scholar 

  29. Kato T, Ishii C, Furusho J, et al.: Early diagnosis of herpes encephalopathy using fluid-attenuated inversion recovery pulse sequence. Pediatr Neurol 1998, 19:58–61.

    Article  PubMed  CAS  Google Scholar 

  30. White ML, Edwards-Brown MK: Fluid attenuated inversion recovery (FLAIR) MRI of herpes encephalitis. J Comput Assist Tomogr 1995, 19:501–502.

    Article  PubMed  CAS  Google Scholar 

  31. Sener RN: Herpes simplex encephalitis: diffusion MR imaging findings. Comput Med Imaging Graph 2001, 25:391–397.

    Article  PubMed  CAS  Google Scholar 

  32. Paivarinta MA, Marttila RJ, Rinne JO, Rinne UK: Decrease in mesencephalic dopamine autoreceptors in experimental herpes simplex encephalitis. J Neural Transm Gen Sect 1992, 89:71–80.

    Article  PubMed  CAS  Google Scholar 

  33. Gea-Banacloche J, Johnson RT, Bagic A, et al.: West Nile virus: pathogenesis and therapeutic options. Ann Intern Med 2004, 140:545–553.

    PubMed  Google Scholar 

  34. Mostashari F, Bunning ML, Kitsutani PT, et al.: Epidemic West Nile encephalitis, New York, 1999: results of a householdbased seroepidemiological survey. Lancet 2001, 358:261–264.

    Article  PubMed  CAS  Google Scholar 

  35. Sejvar JJ, Leis AA, Stokic DS, et al.: Acute flaccid paralysis and West Nile virus infection. Emerg Infect Dis 2003, 9:788–793.

    PubMed  Google Scholar 

  36. Sejvar JJ, Haddad MB, Tierney BC, et al.: Neurologic manifestations and outcome of West Nile virus infection. JAMA 2003, 290:511–515. This is a seminal article regarding the neurologic manifestations or WNV infections.

    Article  PubMed  Google Scholar 

  37. Cushing MM, Brat DJ, Mosunjac MI, et al.: Fatal West Nile virus encephalitis in a renal transplant recipient. Am J Clin Pathol 2004, 121:26–31.

    Article  PubMed  Google Scholar 

  38. DeSalvo D, Roy-Chaudhury P, Peddi R, et al.: West Nile virus encephalitis in organ transplant recipients: another high-risk group for meningoencephalitis and death. Transplantation 2004, 77:466–469.

    Article  PubMed  Google Scholar 

  39. Reddy P, Davenport R, Ratanatharathorn V, et al.: West Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation. Bone Marrow Transplant 2004, 33:109–112.

    Article  PubMed  CAS  Google Scholar 

  40. Iwamoto M, Jernigan DB, Guasch A, et al.: Transmission of West Nile virus from an organ donor to four transplant recipients. N Engl J Med 2003, 348:2196–2203.

    Article  PubMed  Google Scholar 

  41. Kumar D, Prasad GV, Zaltzman J, et al.: Community-acquired West Nile virus infection in solid-organ transplant recipients. Transplantation 2004, 77:399–402.

    Article  PubMed  Google Scholar 

  42. Hardinger KL, Miller B, Storch GA, et al.: West Nile virusassociated meningoencephalitis in two chronically immunosuppressed renal transplant recipients. Am J Transplant 2003, 3:1312–1315.

    Article  PubMed  Google Scholar 

  43. Spiegel R, Miron D, Gavriel H, Horovitz Y: West Nile virus meningoencephalitis complicated by motor aphasia in Hodgkin’s lymphoma. Arch Dis Child 2002, 86:441–442.

    Article  PubMed  CAS  Google Scholar 

  44. Huhn GD, Sejvar JJ, Montgomery SP, Dworkin MS: West Nile virus in the United States: an update on an emerging infectious disease. Am Fam Physician 2003, 68:653–660.

    PubMed  Google Scholar 

  45. O’Leary DR, Marfin AA, Montgomery SP, et al.: The epidemic of West Nile virus in the United States, 2002. Vector Borne Zoonotic Dis 2004, 4:61–70.

    Article  PubMed  Google Scholar 

  46. Armstrong WS, Bashour CA, Smedira NG, et al.: A case of fatal West Nile virus meningoencephalitis associated with receipt of blood transfusions after open heart surgery. Ann Thorac Surg 2003, 76:605–607.

    Article  PubMed  Google Scholar 

  47. Chapa JB, Ahn JT, DiGiovanni LM, Ismail MA: West Nile virus encephalitis during pregnancy. Obstet Gynecol 2003, 102:229–231.

    Article  PubMed  Google Scholar 

  48. Alpert SG, Fergerson J, Noel LP: Intrauterine West Nile virus: ocular and systemic findings. Am J Ophthalmol 2003, 136:733–735.

    Article  PubMed  Google Scholar 

  49. Al Shekhlee A, Katirji B: Electrodiagnostic features of acute paralytic poliomyelitis associated with West Nile virus infection. Muscle Nerve 2004, 29:376–380.

    Article  Google Scholar 

  50. Glass JD, Samuels O, Rich MM: Poliomyelitis due to West Nile virus. N Engl J Med 2002, 347:1280–1281.

    Article  PubMed  Google Scholar 

  51. Jeha LE, Sila CA, Lederman RJ, et al.: West Nile virus infection: a new acute paralytic illness. Neurology 2003, 61:55–59.

    PubMed  CAS  Google Scholar 

  52. Johnson RT, Cornblath DR: Poliomyelitis and flaviviruses. Ann Neurol 2003, 53:691–692.

    Article  PubMed  Google Scholar 

  53. Kelley TW, Prayson RA, Isada CM: Spinal cord disease in West Nile virus infection. N Engl J Med 2003, 348:564–566.

    Article  PubMed  Google Scholar 

  54. Kelley TW, Prayson RA, Ruiz AI, et al.: The neuropathology of West Nile virus meningoencephalitis. A report of two cases and review of the literature. Am J Clin Pathol 2003, 119:749–753.

    Article  PubMed  Google Scholar 

  55. Leis AA, Stokic DS, Polk JL, et al.: A poliomyelitis-like syndrome from West Nile virus infection. N Engl J Med 2002, 347:1279–1280.

    Article  PubMed  Google Scholar 

  56. Leis AA, Stokic DS, Webb RM, et al.: Clinical spectrum of muscle weakness in human West Nile virus infection. Muscle Nerve 2003, 28:302–308.

    Article  PubMed  Google Scholar 

  57. Li J, Loeb JA, Shy ME, et al.: Asymmetric flaccid paralysis: a neuromuscular presentation of West Nile virus infection. Ann Neurol 2003, 53:703–710.

    Article  PubMed  Google Scholar 

  58. Solomon T, Ravi V: Acute flaccid paralysis caused by West Nile virus. Lancet Infect Dis 2003, 3:189–190.

    Article  PubMed  CAS  Google Scholar 

  59. Klein C, Kimiagar I, Pollak L, et al.: Neurological features of West Nile virus infection during the 2000 outbreak in a regional hospital in Israel. J Neurol Sci 2002, 200:63–66.

    Article  PubMed  CAS  Google Scholar 

  60. State University of New York at Buffalo: Guide for the Uniform Data Set for Medical Rehabilitation (including the FIM instrument), Version 5.1. Buffalo, NY 14214-3007: 1997.

  61. Omalu BI, Shakir AA, Wang G, et al.: Fatal fulminant panmeningo-polioencephalitis due to West Nile virus. Brain Pathol 2003, 13:465–472.

    Article  PubMed  Google Scholar 

  62. Bouffard JP, Riudavets MA, Holman R, Rushing EJ: Neuropathology of the brain and spinal cord in human West Nile virus infection. Clin Neuropathol 2004, 23:59–61.

    PubMed  CAS  Google Scholar 

  63. Sampson BA, Ambrosi C, Charlot A, et al.: The pathology of human West Nile Virus infection. Hum Pathol 2000, 31:527–531.

    Article  PubMed  CAS  Google Scholar 

  64. Sampson BA, Armbrustmacher V: West Nile encephalitis: the neuropathology of four fatalities. Ann NY Acad Sci 2001, 951:172–178.

    Article  PubMed  CAS  Google Scholar 

  65. Fratkin JD, Leis AA, Stokic DS, et al.: Spinal cord neuropathology in human West Nile virus infection. Arch Pathol Lab Med 2004, 128:533–537.

    PubMed  Google Scholar 

  66. Agamanolis DP, Leslie MJ, Caveny EA, et al.: Neuropathological findings in West Nile virus encephalitis: a case report. Ann Neurol 2003, 54:547–551.

    Article  PubMed  Google Scholar 

  67. Olsan AD, Milburn JM, Baumgarten KL, Durham HL: Leptomeningeal enhancement in a patient with proven West Nile virus infection. AJR Am J Roentgenol 2003, 181:591–592.

    PubMed  Google Scholar 

  68. Rosas H, Wippold FJ: West Nile virus: case report with MR imaging findings. AJNR Am J Neuroradiol 2003, 24:1376–1378.

    PubMed  Google Scholar 

  69. Solomon T, Fisher AF, Beasley DW, et al.: Natural and nosocomial infection in a patient with West Nile encephalitis and extrapyramidal movement disorders. Clin Infect Dis 2003, 36:E140-E145.

    Article  PubMed  Google Scholar 

  70. Vidwan G, Bryant KK, Puri V, et al.: West Nile virus encephalitis in a child with left-side weakness. Clin Infect Dis 2003, 37:E91-E94.

    Article  PubMed  Google Scholar 

  71. Bosanko CM, Gilroy J, Wang AM, et al.: West nile virus encephalitis involving the substantia nigra: neuroimaging and pathologic findings with literature review. Arch Neurol 2003, 60:1448–1452.

    Article  PubMed  Google Scholar 

  72. Gandelman-Marton R, Kimiagar I, Itzhaki A, et al.: Electroencephalography findings in adult patients with West Nile virus-associated meningitis and meningoencephalitis. Clin Infect Dis 2003, 37:1573–1578.

    Article  PubMed  CAS  Google Scholar 

  73. Cummings JL: Frontal-subcortical circuits and human behavior. J Psychosom Res 1998, 44:627–628.

    Article  PubMed  CAS  Google Scholar 

  74. Cummings JL: Anatomic and behavioral aspects of frontalsubcortical circuits. Ann NY Acad Sci 1995, 769:1–13.

    Article  PubMed  CAS  Google Scholar 

  75. Cummings JL: Subcortical dementia. Neuropsychology, neuropsychiatry, and pathophysiology. Br J Psychiatry 1986, 149:682–697.

    Article  PubMed  CAS  Google Scholar 

  76. Mega MS, Cummings JL: Frontal-subcortical circuits and neuropsychiatric disorders. J Neuropsychiatry Clin Neurosci 1994, 6:358–370.

    PubMed  CAS  Google Scholar 

  77. Royall DR, Lauterbach EC, Cummings JL, et al.: Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 2002, 14:377–405.

    PubMed  Google Scholar 

  78. Tekin S, Cummings JL: Frontal-subcortical neuronal circuits and clinical neuropsychiatry: an update. J Psychosom Res 2002, 53:647–654.

    Article  PubMed  Google Scholar 

  79. Haley M, Retter AS, Fowler D, et al.: The role for intravenous immunoglobulin in the treatment of West Nile virus encephalitis. Clin Infect Dis 2003, 37:E88-E90.

    Article  PubMed  Google Scholar 

  80. Agrawal AG, Petersen LR: Human immunoglobulin as a treatment for West Nile virus infection. J Infect Dis 2003, 188:1–4.

    Article  PubMed  Google Scholar 

  81. Shimoni Z, Niven MJ, Pitlick S, Bulvik S: Treatment of West Nile virus encephalitis with intravenous immunoglobulin. Emerg Infect Dis 2001, 7:759.

    Article  PubMed  CAS  Google Scholar 

  82. Hughes PJ, McLean KA, Lane RJ: Cranial polyneuropathy and brainstem disorder at the time of seroconversion in HIV infection. Int J STD AIDS 1992, 3:60–61.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neuropsychiatry Service, Campus Box C268-25, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, 80262, Denver, CO, USA

    David B. Arciniegas MD & C. Alan Anderson MD

Authors
  1. David B. Arciniegas MD
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. C. Alan Anderson MD
    View author publications

    You can also search for this author inPubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arciniegas, D.B., Anderson, C.A. Viral encephalitis: Neuropsychiatric and neurobehavioral aspects. Curr Psychiatry Rep 6, 372–379 (2004). https://doi.org/10.1007/s11920-004-0024-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-004-0024-x

Keywords