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Neurocritical care2013; 19(1); 111-115; doi: 10.1007/s12028-013-9822-5

Successful management of severe neuroinvasive eastern equine encephalitis.

Abstract: Eastern Equine Encephalitis (EEE) virus is an arbovirus that mostly causes asymptomatic infection in humans; however, some people can develop a neuroinvasive infection associated with a high mortality. Methods: We present a case of a patient with severe neuroinvasive EEE. Results: A 21-year-old man initially presented with headache, fever, and vomiting and was found to have a neutrophilic pleocytosis in his cerebrospinal fluid. He eventually was diagnosed with EEE, treated with high-dose methylprednisolone and intravenous immunoglobulin. His course in the NeuroIntensive Care Unit was complicated by cerebral edema and intracranial hypertension, requiring osmotherapy, pentobarbital and placement of an external ventricular device, and subclinical seizures, necessitating multiple anti-epileptic drugs Conclusions: A multifaceted approach including aggressive management of cerebral edema and ICP as well as treatment with immunomodulating agents and cessation of seizures may prevent brain herniation, secondary neurologic injury and death in patients with EEE. Effective management and treatment in our patient contributed to a dramatic recovery and ultimate good outcome.
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Publication Date: 2013-06-05 PubMed ID: 23733173DOI: 10.1007/s12028-013-9822-5Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research article is about the successful treatment of a severe form of Eastern Equine Encephalitis (EEE), a virus that sometimes causes serious brain infections in humans, using an aggressive and varied approach.

Objective and Methods

  • The researchers studied the case of a 21-year-old male patient with severe neuroinvasive EEE, a typically asymptomatic virus in humans that can occasionally cause serious brain infections.
  • The patient first showed symptoms of headache, fever, and vomiting and was found to have neutrophilic pleocytosis in his cerebrospinal fluid, indicating inflammation.

Results

  • The patient was treated with high-dose methylprednisolone, a type of steroid, and intravenous immunoglobulin, antibodies given to boost the immune system.
  • However, the patient’s time in the NeuroIntensive Care Unit was complicated by cerebral edema (brain swelling) and intracranial hypertension (increased pressure inside the skull), leading to the need for osmotherapy (dehydration) and pentobarbital (sedatives).
  • The patient was also fitted with an external ventricular device to help drain cerebrospinal fluid and relieve pressure, and experienced subclinical seizures requiring the use of multiple anti-epileptic drugs.

Conclusions

  • The researchers concluded that a multifaceted approach including aggressive management of brain swelling and intracranial pressure, treatment with immunomodulating agents to boost the immune system, and cessation of seizures can prevent brain herniation, secondary neurological injury, and death in EEE patients.
  • This extensive treatment plan contributed to a remarkable recovery for the patient discussed in the study, leading to a positive prognosis.
  • This case study provides important insight on potential successful treatment approaches for severe neuroinvasive forms of EEE.

Cite This Article

APA
Wendell LC, Potter NS, Roth JL, Salloway SP, Thompson BB. (2013). Successful management of severe neuroinvasive eastern equine encephalitis. Neurocrit Care, 19(1), 111-115. https://doi.org/10.1007/s12028-013-9822-5

Publication

Neurocritical care
ISSN: 1556-0961
NlmUniqueID: 101156086
Country: United States
Language: English
Volume: 19
Issue: 1
Pages: 111-115

Researcher Affiliations

Wendell, Linda C
  • Departmentsof Neurology,Rhode Island Hospital/Warren Alpert School of Medicine at Brown University, 593 Eddy Street, APC 712, Providence, RI 02903, USA. linda_wendell@brown.edu
Potter, N Stevenson
    Roth, Julie L
      Salloway, Stephen P
        Thompson, Bradford B

          MeSH Terms

          • Anti-Bacterial Agents / therapeutic use
          • Anticonvulsants / therapeutic use
          • Antiviral Agents / therapeutic use
          • Brain Edema / drug therapy
          • Brain Edema / virology
          • Encephalomyelitis, Eastern Equine / drug therapy
          • Epilepsy, Generalized / drug therapy
          • Epilepsy, Generalized / virology
          • Humans
          • Immunologic Factors / therapeutic use
          • Intracranial Pressure
          • Male
          • Phenytoin / therapeutic use
          • Severity of Illness Index
          • Treatment Outcome
          • Young Adult

          References

          This article includes 11 references
          1. Neurocrit Care. 2012 Sep;17 Suppl 1:S66-72
            pubmed: 22961702
          2. Neurol Clin. 2008 May;26(2):427-68, viii
            pubmed: 18514821
          3. MMWR Morb Mortal Wkly Rep. 2012 Jul 13;61(27):510-4
            pubmed: 22785342
          4. N Engl J Med. 1986 Jan 16;314(3):144-9
            pubmed: 3001520
          5. Acta Anaesthesiol Scand. 2006 Jul;50(6):762-5
            pubmed: 16987375
          6. BMC Neurol. 2012 Sep 04;12:87
            pubmed: 22947340
          7. Clin Infect Dis. 2008 Aug 1;47(3):303-27
            pubmed: 18582201
          8. N Engl J Med. 1997 Jun 26;336(26):1867-74
            pubmed: 9197215
          9. J Neurosurg. 1988 Apr;68(4):585-8
            pubmed: 3351587
          10. MMWR Morb Mortal Wkly Rep. 2011 Aug 5;60(30):1009-13
            pubmed: 21814163
          11. Neurology. 2001 Feb 13;56(3):420-1
            pubmed: 11171919

          Citations

          This article has been cited 16 times.
          1. Srichawla BS, Manan MR, Kipkorir V, Dhali A, Diebel S, Sawant T, Zia S, Carrion-Alvarez D, Suteja RC, Nurani K, Găman MA. Neuroinvasion of emerging and re-emerging arboviruses: A scoping review. SAGE Open Med 2024;12:20503121241229847.
            doi: 10.1177/20503121241229847pubmed: 38711470google scholar: lookup
          2. Williams JA, Long SY, Zeng X, Kuehl K, Babka AM, Davis NM, Liu J, Trefry JC, Daye S, Facemire PR, Iversen PL, Bavari S, Pitt ML, Nasar F. Eastern equine encephalitis virus rapidly infects and disseminates in the brain and spinal cord of cynomolgus macaques following aerosol challenge. PLoS Negl Trop Dis 2022 May;16(5):e0010081.
            doi: 10.1371/journal.pntd.0010081pubmed: 35533188google scholar: lookup
          3. Montalvo M, Ayoub D, McGary M, Byrd K, Mahmoud L, Mermel L, Thompson B, Wendell L. Eastern Equine Encephalitis: Case Series in Southern New England and Review of the Literature. Neurol Clin Pract 2021 Oct;11(5):e714-e721.
            doi: 10.1212/CPJ.0000000000001079pubmed: 34840888google scholar: lookup
          4. Dexter EP, Dexter DD, Lindsay CW, Ross RR, Lutwick L. Case of fatal eastern equine encephalitis. IDCases 2021;26:e01288.
            doi: 10.1016/j.idcr.2021.e01288pubmed: 34646732google scholar: lookup
          5. Trefry JC, Rossi FD, Accardi MV, Dorsey BL, Sprague TR, Wollen-Roberts SE, Shamblin JD, Kimmel AE, Glass PJ, Miller LJ, Burke CW, Cardile AP, Smith DR, Bavari S, Authier S, Pratt WD, Pitt ML, Nasar F. The utilization of advance telemetry to investigate critical physiological parameters including electroencephalography in cynomolgus macaques following aerosol challenge with eastern equine encephalitis virus. PLoS Negl Trop Dis 2021 Jun;15(6):e0009424.
            doi: 10.1371/journal.pntd.0009424pubmed: 34138849google scholar: lookup
          6. Albe JR, Ma H, Gilliland TH, McMillen CM, Gardner CL, Boyles DA, Cottle EL, Dunn MD, Lundy JD, O'Malley KJ, Salama N, Walters AW, Pandrea I, Teichert T, Klimstra WB, Reed DS, Hartman AL. Physiological and immunological changes in the brain associated with lethal eastern equine encephalitis virus in macaques. PLoS Pathog 2021 Feb;17(2):e1009308.
            doi: 10.1371/journal.ppat.1009308pubmed: 33534855google scholar: lookup
          7. Wilcox DR, Collens SI, Solomon IH, Mateen FJ, Mukerji SS. Eastern equine encephalitis and use of IV immunoglobulin therapy and high-dose steroids. Neurol Neuroimmunol Neuroinflamm 2021 Jan;8(1).
            doi: 10.1212/NXI.0000000000000917pubmed: 33172962google scholar: lookup
          8. Ma H, Lundy JD, Cottle EL, O'Malley KJ, Trichel AM, Klimstra WB, Hartman AL, Reed DS, Teichert T. Applications of minimally invasive multimodal telemetry for continuous monitoring of brain function and intracranial pressure in macaques with acute viral encephalitis. PLoS One 2020;15(6):e0232381.
            doi: 10.1371/journal.pone.0232381pubmed: 32584818google scholar: lookup
          9. Kapadia RK, Chauhan L, Piquet AL, Tyler KL, Pastula DM. An Overview of Eastern Equine Encephalitis (EEE). Neurohospitalist 2020 Jul;10(3):161-162.
            doi: 10.1177/1941874420905762pubmed: 32549937google scholar: lookup
          10. Sandrock C, Aziz SR. Travel/Tropical Medicine and Pandemic Considerations for the Global Surgeon. Oral Maxillofac Surg Clin North Am 2020 Aug;32(3):407-425.
            doi: 10.1016/j.coms.2020.05.001pubmed: 32473858google scholar: lookup
          11. Cho JJ, Wong JK, Henkel J, DeJesus RO, Nazario-Lopez B. Acute Seroconversion of Eastern Equine Encephalitis Coinfection With California Serogroup Encephalitis Virus. Front Neurol 2019;10:242.
            doi: 10.3389/fneur.2019.00242pubmed: 30941092google scholar: lookup
          12. Pouch SM, Katugaha SB, Shieh WJ, Annambhotla P, Walker WL, Basavaraju SV, Jones J, Huynh T, Reagan-Steiner S, Bhatnagar J, Grimm K, Stramer SL, Gabel J, Lyon GM, Mehta AK, Kandiah P, Neujahr DC, Javidfar J, Subramanian RM, Parekh SM, Shah P, Cooper L, Psotka MA, Radcliffe R, Williams C, Zaki SR, Staples JE, Fischer M, Panella AJ, Lanciotti RS, Laven JJ, Kosoy O, Rabe IB, Gould CV. Transmission of Eastern Equine Encephalitis Virus From an Organ Donor to 3 Transplant Recipients. Clin Infect Dis 2019 Jul 18;69(3):450-458.
            doi: 10.1093/cid/ciy923pubmed: 30371754google scholar: lookup
          13. Solomon IH, Ciarlini PDSC, Santagata S, Ahmed AA, De Girolami U, Prasad S, Mukerji SS. Fatal Eastern Equine Encephalitis in a Patient on Maintenance Rituximab: A Case Report. Open Forum Infect Dis 2017 Winter;4(1):ofx021.
            doi: 10.1093/ofid/ofx021pubmed: 28480291google scholar: lookup
          14. Garlick J, Lee TJ, Shepherd P, Linam WM, Pastula DM, Weinstein S, Schexnayder SM. Locally Acquired Eastern Equine Encephalitis Virus Disease, Arkansas, USA. Emerg Infect Dis 2016 Dec;22(12):2216-2217.
            doi: 10.3201/eid2212.160844pubmed: 27662563google scholar: lookup
          15. Shah KJ, Cherabuddi K. Case of eastern equine encephalitis presenting in winter. BMJ Case Rep 2016 May 10;2016.
            doi: 10.1136/bcr-2016-215270pubmed: 27165999google scholar: lookup
          16. Mukerji SS, Lam AD, Wilson MR. Eastern Equine Encephalitis Treated With Intravenous Immunoglobulins. Neurohospitalist 2016 Jan;6(1):29-31.
            doi: 10.1177/1941874415578533pubmed: 26740855google scholar: lookup
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