Chapter 8 : Clinical Syndromes Including Smallpox and Measles

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This chapter focuses on the central nervous system (CNS) syndromes that can follow in the wake of viral infections but may also present after immunization or without a recognized preceding event. The CNS dysfunction does not appear to result from viral replication in the brain but rather from a host immune response in the brain in the wake of a systemic infection. With the cessation of smallpox vaccination and the decline of recognizable childhood illnesses because of the implementation of measles-mumps-rubella and varicella-zoster virus (VZV) vaccination in the industrialized nations, many of the identifiable precedents to this class of encephalitis have been eliminated. Smallpox has reared its head as a potential weapon of bioterrorism. Measles remains an enormous problem worldwide in developing nations. Hence, smallpox, its vaccination, and measles are specifically covered in this chapter. The spread of smallpox depended primarily on person-to-person contact by respiratory droplets and vesicle fluid, but contaminated bedclothes or clothing also contributed. Diagnosis of smallpox depended on observation of the characteristic rash and on laboratory studies. Therapy can be applied after contact with a known case. Smallpox could be prevented or modified by vaccination up to 4 days after exposure. Measles is associated with a significant viremia during the incubation stage, and measurable circulating antibody occurs with the appearance of the rash. The diagnosis is dependent on the sequence of an acute disseminated encephalomyelitis (ADEM) following clinical measles, with supportive findings on magnetic resonance imaging (MRI).

Citation: Booss J, Esiri M. 2003. Clinical Syndromes Including Smallpox and Measles, p 107-125. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch8
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Image of FIGURE 8.1

MRI of ADEM with lesions in the brain and spinal cord, (a) Tl-weighted MRI of brain with contrast, demonstrating enhancing lesion surrounded by an area of hypointensity consistent with nonenhancing portion of lesion and edema, (b) Tl-weighted MRI with contrast of cervical spinal cord, demonstrating enhancing lesion. Courtesy of Gordon Sze, Yale University School of Medicine.

Citation: Booss J, Esiri M. 2003. Clinical Syndromes Including Smallpox and Measles, p 107-125. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch8
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Types of disorders to be considered in the evaluation of acute toxic encephalopathy a

Citation: Booss J, Esiri M. 2003. Clinical Syndromes Including Smallpox and Measles, p 107-125. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch8
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Representative viral infections and mechanisms of stroke

Citation: Booss J, Esiri M. 2003. Clinical Syndromes Including Smallpox and Measles, p 107-125. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch8
Generic image for table

Clinical types of smallpox and adverse responses to vaccination

Citation: Booss J, Esiri M. 2003. Clinical Syndromes Including Smallpox and Measles, p 107-125. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch8
Generic image for table

Cases of neurological dysfunction following smallpox vaccination a

Citation: Booss J, Esiri M. 2003. Clinical Syndromes Including Smallpox and Measles, p 107-125. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch8
Generic image for table

Types of CNS involvement associated with measles infection a

Citation: Booss J, Esiri M. 2003. Clinical Syndromes Including Smallpox and Measles, p 107-125. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch8

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