Two children are described who suddenly developed an encephalitic illness with intractable bilateral facial seizures. The seizures subsided over several days, but the children were left with the signs of pseudobulbar palsy and are unable to speak or swallow effectively. Bilateral destructive lesions in the opercular regions evolved on computed tomographic scans. Both children were treated with acyclovir relatively early in the illness, and cerebrospinal fluid and serum antibodies support the diagnosis of herpes simplex virus encephalitis. (J Child Neurol 1989;4.-131-136).
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References
1.
Ford FR: Diseases of the Nervous System in Infancy, Childhood and Adolescence , ed 4. Springfield, IL, Charles C Thomas, 1960, p 177.
2.
Swaiman KF, Wright FS (eds): The Practice of Pediatric Neurology, ed 2. Saint Louis, CV Mosby , 1982, p 447.
3.
Tilney F., Morrison JF: Pseudobulbar palsy, clinically and pathologically considered, with the clinical report of five cases. J Nerv Ment Dis1912 ;39:505-535.
4.
Langworthy OR , Hesser FH: Syndrome of pseudobulbar palsv, an anatomic and physiologic analysis. Arch Intern Med1940;65:106-121.
5.
Benson DF: Aphasia. Alexia and Agraphia. New York, Churchill Livingstone, 1979, p 159-160.
6.
De Jong RN: The Neurological Examination, ed 3. New York, Hoeber, 1967 , p 353-354.
7.
Helgason C., Wilbur A., Weiss A., et al: Acute pseudobulbar mutism due to discrete bilateral capsular infarction in the territory of the anterior choroidal artery. Brain1988;111:507-524.
8.
Cummings JL, Benson DF, Houlihan JP, Gosenfeld LF: Mutism: Loss of neocortical and limbic vocalization. J Nerv Ment Dis1983;171:255-259.
9.
Foix C., Chavany JA, Marie J.: Diplegie facio-linguo-masticatrice d'origine cortico-sous-cortical sans paralysie des membres. Rev Neurol1926 ;33:214-219.
10.
Magnus A., cited by Mariani C., Spinnler H., Sterzi R., Vallar G.: Bilateral perisylvian softenings: Bilateral anterior opercular syndrome (Foix-Chavany-Marie syndrome). J Neurol1980 ;223: 269-284.
11.
Bruyn GW, Gathier JC: The operculum syndrome, in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology, vol. 2. Localization in Clinical Neurology. Amsterdam, North Holland Publishing Co, 1969;2:776-783.
12.
Ferrari G., Boninsegna C., Beltramello A.: Foix-Chavany syndrome: CT study and clinical report of 3 cases. Neuroradiology1979;18:41-42.
13.
Sandyk R., Brennan MJW: the operculum syndrome. J Comput Assist Tomogr1983;7:130-131.
Chateau R., Fau R., Groslambert R., et al: A propos de trois observations de diplegie linguo-facio-masticatrice d'origine corticale: La forme de l' adulte et celle de l'enfant. Rev Neurol1966;114:390-395.
16.
Graff-Radford NR, Bosch EP, Stears JC, Tranel D.: Developmental Foix-Chavany-Marie syndrome in identical twins. Ann Neurol1986; 20:632-635.
Skoldenberg B., Forsgren M., Alestig K., et al: Acyclovir versus vidarabine in herpes simplex encephalitis: Randomised multi-centre study in consecutive Swedish patients. Lancet1984;2: 707-711.
19.
Whitley RJ, Alford CA, Hirsch MS: Vidarabine versus acyclovir therapy in herpes simplex encephalitis . N Engl J Med1986;314: 144-149.
20.
Olson LC, Buescher EL, Artenstein MS, Parkman PD: Herpes virus infections of the human central nervous system. N Engl J Med1967;277:1271-1277.
21.
Whitley RJ, Soong S-J., Dolin R., et al: Adenine arabinoside therapy of biopsy-proved herpes simplex encephalitis. N Engl J Med1977;297:289-294.
Corey L., Spear PG: Infections with herpes simplex virus (second of two parts). N Engl J Med1986;314:749-757.
26.
Hierons R., Janota I., Corsellis JAN: The late effects of necrotising encephalitis of the temporal lobes and limbic areas: A clinicopathological study of 10 cases. Psychol Med1978;8:21-42.
27.
Esiri MM: Herpes simplex encephalitis. An immunohistological study of the distribution of viral antigen within the brain. J Neurol Sci1982;54:209-226.
28.
Davis JM, Davis KR, Kleinman GM, et al: Computed tomography of herpes simplex encephalitis with clinicopathological correlation. Radiology1978;129:409-417.
29.
Schroth G., Gawehn J., Thron A., et al: Early diagnosis of herpes simplex encephalitis by MRI. Neurology1987;37:179-183.
30.
Kowal-Vern A., Patel J., Krieger P., et al: Magnetic resonance imaging in an unusual presentation of herpes encephalitis. Neuropediatrics1988;19:49-51.
31.
Enzmann DR, Ranson B., Norman MD, Talberth E.: Computed tomography of herpes simplex encephalitis. Radiology1978; 129:419-425.
32.
Schauseil-Zipf U., Harden A., Hoare RD, et al: Early diagnosis of herpes simplex encephalitis in childhood. Eur J Pediatr1982 ;138:154-161.
33.
McCrossin DB , Gilbert GL: Herpes simplex virus encephalitis in children . Med J Aust1986;144;711-713.
34.
Arvin AM, Johnson RT, Whitley RT, et al: Consensus: Management of the patient with herpes simplex encephalitis . Pediatr Infect Dis J1987;6:2-5.
35.
Barthez MA, Billard C., Santini JJ, et al: Relapse of herpes simplex encephalitis. Neuropediatrics1987;18:3-7.
36.
Gutman LT, Wilfert CM, Eppes S.: Herpes simplex virus encephalitis in children: Analysis of cerebrospinal fluid and progressive neurodevelopmental deterioration. J Infect Dis1986;154:415-421.
37.
Adams RD, Victor M.: Principles of Neurology, ed 2. New York, McGraw-Hill, 1981, p 323.
