What is Herpes Encephalitis?

Herpes Encephalitis which is otherwise known as herpetic brainstem encephalitis, herpetic meningoencephalitis or HSE is a medical condition that, according to statistics, is responsible for the 10 percent of the persons who are suffering from encephalitis. Encephalitis is a medical condition that happens when there is an inflammation in the brain because of viral infections and other kinds of infections. Other would define herpes encephalitis as a viral kind of encephalitis. Meanwhile, herpes simplex virus (1) is a common blister that results to the person experiencing cold sores or small blisters in his or her nose, eyes, eyelid or lips. It can also progress and affect the brain portion of the person. It can lead to the severe kind of amnesic syndrome which results to the damage to the medical part of the temporal lobes.

Fig 1 – Actual Picture of a Unilateral Temporal Lobe Necrosis as seen in Herpes encephalitis

The herpes simplex virus which is found in the herpes encephalitis can occur to anybody at any age and at anytime. According to statistics, United Kingdom has 200 cases of persons who suffer from herpes encephalitis. Yet, despite of the huge number recorded, this disease condition is sometimes under diagnosed.

Herpes Encephalitis Symptoms

In preventing the under diagnosis of herpes encephalitis, one must note the symptoms associated with herpes encephalitis. The symptoms that are present in persons suffering from herpes encephalitis can be variable to one person to another. The common symptoms are as follows:

• Memory loss
• Dysphasia
• Headache
• Fever
• Hyperactivity
• Seizure
• Vomiting
• Loss of visual field
• Altered consciousness
• Behavior changes
• Anorexia
• Swelling of the temporal lobe
• There is an increase protein in the person’s blood lymphocytes and cerebrospinal fluid
• One side muscle weakness
• Stiff neck
• General weakness
• Coma
• Poor feeding
• Stiffness of the body

Herpes Encephalitis Causes

Normally, according to research, herpes encephalitis can occur about 5 to 10 days or after the occurrence of childhood illness. Sometimes, the herpes encephalitis can occur in weeks, months, or even in years after the first viral infection occurs.

Persons that suffer from herpes encephalitis experiences the disease condition because of either:

• Herpes Simplex virus type I
• Herpes Simplex virus type II

Among the type of herpes simplex virus mentioned, usually persons that suffer from herpes encephalitis have herpes simplex virus type I. When a person has herpes simplex virus type I, they usually have the disease condition at the early stage of his or her life. Yet, they may not notice it for the person may have an asymptomatic infection or an infection that has no present symptoms.

The herpes encephalitis can be widespread yet it is rare in nature. The herpes encephalitis is an infection that enters the brain because of the following reasons:

• It enters the blood brain barrier
• It enters the central nervous system
• It enters via the nerves pathways that links the brain to other areas

Herpes Encephalitis Treatment

As mentioned earlier, herpes encephalitis is a brain inflammation that can also be medically referred to encephalitis. The herpes encephalitis is a viral infection that attacks the person’s neurons which leads to the hemorrhagic process especially in the inferior part of the medical temporal and frontal lobes of the person’s brain. Once, one is positive with herpes encephalitis, there is a need for special medical attention to prevent the deterioration of the person’s central nervous system and avoid any fatal complications associated with herpes encephalitis. The treatment for herpes encephalitis is symptomatic in approach. Hence, the treatment may also vary basing on the symptoms experienced by the person. The following are the treatment given and provided to persons who are suffering from herpes encephalitis:

Initial treatment

Initial treatment is given to persons who have herpes encephalitis. It includes the following treatment management:

• General nutritional support
• Fluid support
• Airway management
• Breathing management
• Circulation management
• Proper universal precaution is also given
• Monitoring of seizure and increase in intracranial pressure

Steroid treatment

Steroid treatment is given to persons who suffer from herpes encephalitis to suppress the response of the immune system which will limit the replication of the virus. Aside from that, it is reported to reduce the edema of the person’s brain especially in those persons who suffer from the severe form of the herpes encephalitis.

Antiviral treatment

This is the common treatment given to persons with herpes encephalitis. Under this drug category, you can find acyclovir which is a medical choice for the herpes encephalitis. The good thing about this drug is that it has lesser side effects which make it an ideal drug to persons suffering from herpes encephalitis. This is often given intravenously. It usually is given for a period of 14-21 days.

Herpes Encephalitis Prognosis

The prognosis for persons with herpes encephalitis will depend greatly on the viral infection or the agent which is involved, the treatment given, and the severity of the herpes encephalitis itself. Persons who have a mild form of herpes encephalitis usually achieve full recovery but the process towards recovery is slow. Generally, persons with herpes encephalitis needs long term medication, supportive care and therapy for them to recover fully.

Fig 2 – A Severe Form of Herpes Encephalitis Affecting both the Temporal Lobes

Is Herpes Encephalitis Contagious?

Through direct contact, herpes encephalitis is rarely forwarded to persons who were never infected with herpes encephalitis. Those who have never been infected with herpes encephalitis are at high risk in acquiring herpes and recurrence of the sores in the future. Hence, a person with herpes simplex is needed to be given with contact precaution because they have the tendency to inflict other persons.

What is Sinus Headache?

Sinus Headache is a condition of your sinuses, which is found lining in your membranes, which is inflamed and swollen. It may accompany the sinusitis disorder. It occurs as a result of a congestion or trapped mucus that has built up in the person’s paranasal cavities of the sinus.

The sinuses are cavities that are bony air filled which is connected to the head through the nose through the ostia, which is a small opening in the nose. When a person gets an allergy attack, sinus infection or a cold, the openings can be infected leading to its mucus membranes to be inflamed and the cavity to be blocked by excess mucous that cannot be drained. It is with this excess mucous which creates pressure in the person’s head and leading to the painful sinus headache experience.

Symptoms of Sinus Headache

When a person has sinus headache, he or she will manifest the following symptoms:

1. Fever
2. Cough
3. Fatigue
4. Sore throat
5. Swollen lymph nodes
6. Chills
7. Body malaise
8. Myalgias or achy muscles
9. Pain that may worsen during lying down or bending
10. Pressure and fullness in the person’s brow, cheeks or forehead.
11. Achy feeling in the upper teeth
12. Blood tinged or yellow green nasal discharge
13. Headaches with congestion
14. Facial Swelling
15. Head pain which is like a migraine or tension headache
16. A light headed feeling
17. Blocked nasal passages (early sign)
18. Slight buzzing or ringing of the patient’s ears
19. Discharge of the eyes
20. Post nasal Drip
21. Altered taste
22. Throat irritations

Causes of Sinus Headache

When one will diagnose with having sinus headaches, it may be due to:

1. Environmental triggers like pollen, mold and cigarette smokes which will lead to intensifying the symptoms and the sinus headache’s severity
2. Allergic Rhinitis
3. Respiratory infections
4. Activities that involve air pressure change such as swimming, scuba diving or airplane travel
5. Exposure to an allergic substance or exposure to cold
6. Lying down or bending forward
7. Bacterial infections
8. Fungal infections
9. Impaired immune system
10. Structural problems with the person’s nasal cavity

Diagnosis of Sinus Headache

In diagnosing a person having a sinus headache is done first through thorough physical examination and through thorough assessment. The physician may also conduct some of the following tests:

Imaging Tests

Imaging tests including MRI and CT scan. CT scans uses computer in order to have a cross sectional images of the head and brain including the person’s sinuses. It combines images of x-ray units which rotate around the person’s body. With the MRIs, it uses radio waves and magnetic field to create the same cross-sectional images of the brain structures.

Nasal Endoscopy

It is here that a thin tube with light is called endoscope, is used to examine the nasal passages of the person.

Mucus Testing

The physician may also test mucus samples coming from the patient’s nose to determine if the cause is either fungal or bacterial kind of infection.

Treatment (Relief) of Sinus Headache

The goal of treatment in the sinus headache is to reduce the underlying sinus inflammation. The treatment may include the following:

Medications

Antibiotics

It is prescribe usually in one to two weeks. You must take the entire course as prescribe even when the symptoms vanish. It is prescribed to kill the bacteria or germs that cause the infection.

Decongestants

This kind of drugs decreases the congestion in the nasal area through constricting the blood vessels and blood flow reduction to the nasal passage.

Antihistamines

It works by blocking the histamine in your body. It is available in nasal spray and oral forms and can be bought over the counter or with prescription.

Corticosteroids

It can be prescribe especially if the cause of the sinus headache is due to allergic reaction or because of inflammatory response.

Surgical Operation

This is considered the last option. Since it is only done if the patient himself or herself has structural problems in his or her nasal cavity which lead to having sinus headaches.

Prevention of Sinus Headache

In preventing sinus headache from occurring and keeping your sinuses healthy, you may do the following:

Avoid irritants

As much as possible you need to avoid irritants that will lead to sinus headaches. Irritants such as cigar, cigarette, other air pollutants and pipe smoke should be avoided.

Use humidifier

You need to avoid the moisture that dry indoor air will prevent you from having sinus headaches and sinusitis. Also high amount of indoor humidity will lead to growth of dust mite and molds in your houses. So it is better that you don’t over redo humidifying.

Wash hands often

It is the safest, cheapest and most convenient way of preventing sinus headache. You just need soap and water.

Home Remedies of Sinus Headache

You can also do home remedial treatment in treating your sinus headache, such as:

Correct Diet

You start with the basic, which is to correct your diet. Wrong consumption of foods may lead to allergies which will lead to having sinus headaches. You need a diet that has animal protein, water, whole grains and a variety of cooked vegetables. Also, you need to avoid over-eating, irregular meals and eating late in the evening which can lead to sinus headache.

Avoiding Sickness such as cough or flu’s

You need to increase your immune system by ingesting vitamins and avoiding stress and alcoholic beverages and, of course, smoking.

Cool compress

Cool compress of the person’s forehead could help in alleviating the pain. It is the easy solution when a sinus headache occurs.

Complications of Sinus Headache

Here are the complications when one has sinus headache:

Meningitis

It is the inflammation of the brain and spinal cords protective membranes. When the sinus is infected it can lead to meningitis.

Anosmia

If the sinus headache worsens, the inflammation also worsens and it can lead to damaging of the olfactory nerve endings leading to the loss of smell.

Orbital Cellulitis

When the infection of the sinus spreads into the surrounding eye socket it will lead to having orbital cellulitis.

Sinus Mucoceles

It is usually a benign expansive mass which are fluid filled and which are located in the paranasal sinuses. The affected region is usually the ethmoid and frontal sinuses.

Antibiotic resistance

Antibiotic is one medication prescribed for persons having sinus headaches. It occurs when the person suddenly stops the medication and lead to incomplete course of prescribed antibiotics which will lead to antibiotic resistance.

What is Priapism?

Priapism is a medical condition involving the persistent erection of the penis or the clitoris, despite absence of stimulation that can last up to four hours. Because of the persistent erection for hours, it leads to severe pain because of poor blood circulation.

Priapism is considered a medical emergency because it may lead to severe ischemia of the tissues. Early emergency treatment often prevents functional disabilities such as erectile dysfunction and disfiguring of the penis.

Priapism usually results from the trapping of blood in the penis leading to prolonged erection. Priapism can affect both males and female and can also affect all age groups.

Persistent erection of the penis or priapism

Image source: drugster.info

Types

It involves different types such as:

Ischemic or low flow

This type results from the inability of the blood to leave the penis after going to the area during stimulation. Up to 90% of priapism cases are ischemic in type. Males with leukemia, malaria or sickle cell anemia may suffer from ischemic priapism.

Non-ischemic or high flow

Non-ischemic priapism occurs because of too much blood that flows in the penis. It often results from rupture of artery in the penis resulting in inability to enter the circulation.

Stuttering

Stuttering or recurring occurs on and off. Stuttering is usually painful.

Nocturnal

Nocturnal priapism occurs during night time and may disturb the person from sleep.

Symptoms

Symptoms of priapism include:

• Prolonged erection of more than 4 hours
• Prolonged erection is the classical sign of priapism. Although the exact number of hours is still under debate, a significantly prolonged erection is a characteristic of priapism. The penis normally erects because of vasodilatation of the blood vessels in the penis during stimulation, but normally returns to its flaccid, non-erected state. However, in priapism, there is inability to return the blood in the circulation, or there is more blood that rushes in, leading to prolonged erection.
• Erection without sexual stimulation or there is persistent stimulation, despite the discontinuance of stimulation
• The erection of the penis is normally stimulated by both physical and psychological stimulation. When the stimulation is removed, the erection usually subsides and the penis goes back to its flaccid state. However, there is sustained erection in priapism not directly related to stimulation.
• Rigid shaft of the penis
• Because of intense erection, the shaft becomes very rigid. However, some types of priapism do not result to which.
• Can be painful or painless
• Ischemic priapism results in painful penis because of increased amount of blood that stays in the penis, which is not able to circulate in the body. Non-ischemic priapism on the other hand, is not painful because there is only increased amount of blood that circulates in the area, but is still able to drain in the venous circulation.

Causes

The causes are mainly related to neurovascular problems. These conditions may include:

Hematologic Conditions

Diseases that affect the circulation such as sickle cell disease, thalassemia, Fabry disease and leukemia may cause priapism because of sluggish blood flow resulting from the viscous blood. Because of this, the blood may not be able to escape from the blood vessels in the penis.

Neurologic Disorders

Problems such as spinal cord lesions and spinal cord trauma because of over stimulation of the autonomic nervous system, the one responsible for penile erection, may cause priapism.

G6PD Deficiency

A deficiency in glucose-6 phosphate dehydrogenase leads to low levels of NADPH, a co-factor responsible for the synthesis of nitric oxide. When nitric oxide is reduced, there will be prolonged erection.

Increased Adenosine Levels

Adenosine is responsible for the dilation of blood vessels. When it is significantly increased, it may lead to dilation of the blood vessels in the penis leading to priapism.

Medications

Intake of medications such as papaverine alprostadil causes priapism as a side-effect. This medication is a treatment for erectile dysfunction. Other medicines may include anticoagulants, antihypertensive medications, antidepressants and antipsychotics. Use of illegal drugs such as marijuana and cocaine may also cause priapism.

Black widow spider bites

The injury may result in the affectation of the nervous system leading to priapism.

Diagnosis

Medical history is the initial diagnostic tool. Other diagnostic tests for priapism include:

Blood gas measurement

This involves the collection of a blood sample in the penis. This checks the level of blood gases such as oxygen in the penile circulation.

Blood tests

The amount of red blood cells and platelets may also be taken to determine hematologic conditions such sickle cell disease and leukemia.

Toxicology tests

These are done to check the presence of illegal drugs in the blood.

Ultrasound

A duplex ultrasonography is also done to assess the blood flow in the penis and may specifically determine the type of priapism, either ischemic or non-ischemic.

What is the Treatment?

Treatment regimen for priapism involves both medical and surgical interventions, which include:

Medications

• Vasoconstrictors
• Pseudoephedrine is usually given to patients to constrict the blood vessels in the penis. Pseudoephedrine being an alpha agonist is a vasoconstrictor, thereby reducing the dilation in the area leading to priapism. Amphetamine drugs may also be given. Intracavernosal injection of phenylephrine may also be used when other medications are not effective. This involves the injection of phenylephrine in the corpus cavernosum in the penis and may involve hemodynamic monitoring because this drug may cause bradycardia, hypertension, arrhythmia and tachycardia.
• Beta-2 agonists
• Terbutaline may also be given to allow smooth muscle relaxation in the corpus cavernosum leading to reduced erection.
• Methylene blue
• Methylene blue is administered intracavernously, but should not be used as a treatment for recurrent priapism because it may lead to tissue necrosis in the penis.

Blood aspiration

Aspirating blood in the penis under local anesthesia is a possible medical emergency treatment to reduce the amount of blood in the penis.

Surgery

Surgical shunts may also be created to allow the blood to flow from the erected corpus cavernosum to the corpus spongiosum in the penis, which allows venous return of blood. Distal shunts (Winter’s shunt) involve the creation of the shunt in the glans penis. Proximal shunts (Quackel’s shunt) on the other hand involve the surgical incision in the perineum.

Figure 2 – Surgical intervention for Priapism

Image source: indianjcancer.com