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Cytoplasmic Tubular Aggregates and Nuclear Filamentous Bodies in Two Suspected Cases of Viral Encephalitis

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Cytoplasmic Tubular Aggregates and Nuclear Filamentous Bodies in Two Suspected Cases of Viral Encephalitis THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES % Cytoplasmic Tubular Aggregates and Nuclear Filamentous Bodies in Two Suspected Cases of Viral Encephalitis DIKRAN S. HOROUPIAN, R. T. ROSS, MARK J. GURWITH, JAN HOOGSTRATEN SUMMARY Two suspected cases of INTRODUCTION On admission, she was alert but had viral encephalitis are presented. Viral difficulty understanding commands. Her Cytoplasmic paramyxovirus-like nucleocapsids were not seen, but cytop­ optic fundi, visual fields and cranial lasmic paramyxovirus-like aggregates aggregates (Baringer and Swoveland, nerves were normal. She had bilateral and nuclear filamentous bodies were fre­ 1972) and whorled filamentous nuc­ flexor plantar responses. Her tempera­ quently encountered. Both structures lear bodies (Zu Rhein and Chou, ture was normal. Her chest, skull films, a were seen in the same cell. Contrary to 1968) have been frequently described left common carotid angiogram, and a other reports, the cytoplasmic aggre­ in association with virus induced in­ brain scan were all normal. gates were mostly observed in fectious and neoplastic conditions. Other investigations revealed a hemo­ hematogenous mononuclear cells, less To our knowledge, these two struc­ globin of 13.0 gms. %, WBC 8900/cmm. frequently in neuronal cell elements and tures have not been described in the with a normal differential and an erythro­ rarely in endothelial cells. The non­ same patient, and the appearance of cyte sedimentation rate of 38 mm. in one specific nature of these structures is em­ hour. Serum bilirubin, S.G.O.T., C.P.K. phasized. the former, at least in humans, has been usually confined to endothelial and alkaline phosphatase were all nor­ mal. Urinalysis, a Monospot test and in­ cells and less frequently to mononuc­ direct fluorescent antibody titers for tox­ lear cells (Baringer, 1971). This paper oplasmosis were all negative. E.E.G. RESUME: Deux cas presumes d'ence- deals with two instances of suspected phalite virale furent etudies; aucune showed evidence of a severe disturbance viral encephalitis in which these of the left temporal lobe. Spinal fluid ex­ nucleocapside virale ne fut decelee, structures were present in the same mais on denombra beaucoup d'aggre- amination showed a glucose of 55 mgs. %, biopsy material and the cytoplasmic gats cytoplasmiques, semblables a des protein 17 mgs. %, 19 lymphocytes and 1 paramixovirus, ainsi que des corps aggregates were found in neuronal redcell/cmm. Cultures of C.S.F. for bac­ nucleaires filamenteux. Ceux-ci coex- cell elements. teria, fungi and mycobacteria were all istaient dans la meme cellule. Contraire- negative. ment a d'autres rapports, la plupart des On her third hospital day she under­ aggregats cytoplasmiques furent decou- CASE REPORT 1 went a left temporal lobe brain biopsy. On verts dans des cellules mononucleates Miss M.A., a 16-year-old high school the basis of the pathology report it was hematogenes, certains dans des elements student, was admitted to hospital on Sep­ decided to treat her as a suspect herpes neuronaux, et tres peu dans des cellules tember 17, 1972. Her family said that she simplex encephalitis with idoxuridine endotheliales. Le caractere non specifi- had been unwell for one week and com­ (IUDR) which was administered for five que de ces structures est souligne. plained of paraesthesiae in her mouth, days, four grams per day. By the last day gums and teeth. of therapy, her S.G.O.T. was 235, L.D.H. 220, and alkaline phosphatase 62 Two days before admission she com­ I.U. Her S.G.O.T. remained elevated for plained of anorexia, vomited once and 50 days, although by the date of discharge stopped eating entirely. She developed it was normal. Her bilirubin rose to 1.8 intermittent paraesthesiae of the right foot and arm which lasted for several mi­ mgs. %. nutes at a time and disappeared for sev­ On the ninth hospital day her level of eral hours. She gradually became dys- consciousness was further depressed and phasic, apprehensive and began to ex­ lumbar puncture was repeated. Clear perience violent mood changes. Thirty- fluid under elevated pressure was re­ From the Department of Pathology and Medicine six hours prior to admission she had a moved containing 16 mgs. % of protein Health Sciences Centre and Faculty of Medicine, nocturnal, generalized epileptic seizure. and 20 lymphocytes per cmm. All other University of Manitoba, Winnipeg, Canada. The next day her dysphasia was much constituents were normal. Reprint address: Dr. D. S. Horoupian, worse, but she managed to make it known Her subsequent hospital course was Neuropathology Unit, Department of Pathology, that she was experiencing constant right Health Sciences Centre, 700 William Avenue, Win­ characterized by severe aspiration nipeg, Manitoba R3E 0Z3 Canada. face, arm and leg paraesthesiae. pneumonia, transient renal failure and a 98 - MAY 1974 Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.126, on 01 Oct 2021 at 09:44:18, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0317167100019648 # LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES bleeding diathesis due to throm­ bar puncture revealed clear colorless 5% glutaraldehyde in phosphate buf­ bocytopenia. fluid with one white blood cell and 53 red fer at pH 7.3 and post fixed in buf­ By October 24th, her mental status had cells. All cultures were negative. Protein fered osmic acid for one hour. The improved. She could not speak or feed was 25 mg. % and sugar was 112 mg. %. tissues were washed with distilled Subsequent spinal taps were essentially herself and was doubly incontinent. At water and put in 2% aqueous solution times she had spontaneous violent rages. not altered. An echoencephalogram was normal. An E.E.G. was very abnormal, of uranyl acetate for 25 minutes. These were thought to be epileptic and After dehydration in ethanol, the tis­ were controlled with diphenylhydantoin but with non-specific findings. A brain and primidone therapy. scan suggested increased activity in the sues were embedded in SPURR plas­ right posterior fossa, but a right brachial tic and the thin sections were stained After two months stay in hospital she angiogram showed no abnormalities. with lead citrate. was discharged to a chronic disease hos­ Chest X-ray and E.K.G. were normal. pital, completely aphasic and needing in­ Virus isolation from all specimens, tensive nursing care. She returned home On the 5th hospital day the patient including the brain biopsy, was at­ on the 30th of January, 1973, at which underwent a right temporal lobe brain tempted in primary human amnion, biopsy and was immediately started on time she was capable of dressing and WI-38, and African Green Monkey feeding herself and fully ambulatory. She IUDR. The IUDR was discontinued after two days when the pathological report on tissue cultures. All serological tests was able to spell and write letters, read were done by the microtitre comple­ the newspaper, add, subtract, multiply the brain biopsy was reported to be non­ ment fixation method using two units and divide. Physical examination showed diagnostic. Routine cultures of the brain no abnormalities except for a speech biopsy for fungi, mycobacteriae and vir­ of complement and two units of an­ stammer. uses were negative. tigen. Immunofluorescence for The patient's subsequent hospital Herpes virus hominis on the brain course was complicated by a left lower specimen was also attempted. CASE REPORT 2 - (C.W.) lobe pneumonia and a urinary tract in­ This 12-year-old Jamaican boy was fection and he remained febrile approx­ admitted on the 14th of February, 1973 imately 30 days. because of fever and a convulsion. The patient had lived in Canada for the last On the 13th hospital day he began to four years, but on the 23rd of December, respond to verbal commands and after 1972 he went to Jamaica for a vacation. one month he responded fully, and was n^, While in Jamaica he had fever lasting able to repeat commands and walk. His for one day on the 5th and the 12th of neurological examination continued to January, 1973. He returned to Winnipeg show no focal abnormalities. L.D.H. and on January 13th, 1973 and was treated S.G.O.T. remained elevated throughout with Synalar cream and clindamycin for his stay in hospital. The last L.D.H. was "infected mosquito bites". On the 10th of 260, but S.G.O.T. had fallen to 60 I.U. February, 1973, he developed fever, His alkaline phosphatase rose to 215 chills, headache, vomiting and diarrhea while in hospital and when last measured and on the day of admission he was found was 175 I.U. Because of the persistent 4 . on the floor unconscious. abnormal liver function, a liver biopsy was done which was considered to be v His past history was unremarkable. normal. ry-' - There was no history of convulsive dis­ Nine months later, the patient still suf­ order, drug abuse or head injury. fers from local seizures and manifests . • ,* * *-* * At admission the patient responded serious behavioral difficulties. only to pain and developed a generalized seizure while in the emergency room. There were no localizing neurological MATERIALS AND METHODS signs, although bilateral Babinski signs The brain biopsy was obtained were present. from the left temporal lobe in case While in the hospital, the patient con­ No. 1 and from the right side in tinued to have seizures, both generalized case No. 2. The specimen was and focal, involving the right side. He remained febrile and finally required a divided into four parts for: light • «? tracheostomy. Laboratory findings in­ microscopy, histochemistry, electron cluded a hemoglobin of 11.2 gms. %, a microscopy and virus studies. fSS&V .V white cell count of 9,000/cmm.
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