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Article
June 1964

Hyponatremia With Herpes Simplex Encephalitis: Possible Relationship of Limbic Lesions and ADH Secretion

Author Affiliations

PHILADELPHIA
From the Division of Neurosurgery and the Department of Medicine, Jefferson Medical College and Hospital.

Arch Neurol. 1964;10(6):595-603. doi:10.1001/archneur.1964.00460180061006
Abstract

Introduction  This report describes a patient with herpes simplex encephalitis who exhibited, during the acute stage of his illness, severe, transient hyponatremia with renal sodium loss presumably induced by inappropriate and excessive production of antidiuretic hormone. Although this syndrome often referred to as "cerebral salt wasting"1-3 has been seen in patients with various brain lesions,4-6 this is the first instance, to our knowledge, where it has been associated with verified herpes simplex encephalitis. This patient is still alive, and the exact topography of his cerebral lesion cannot be precisely delineated. Nonetheless, the clinical picture and ancillary diagnostic studies are compatible with a bilateral diffuse encephalopathy involving predominantly hippocampal and adjacent mesial temporal regions.Because of the predilection of herpes simplex encephalitis for producing destructive lesions in those regions of the brain comprising the "limbic system"7-9 we have discussed the relationship of the limbic system and the hypothalamic-postpituitary

References
1.
Uosm indicates osmolality of urine.
2.
Posm indicates osmolality of plasma (normal 285-300).
3.
Cor indicates endogenous creatinine clearance (an estimate of renal glomerular filtration rate—normal 100-120 cc/min).
4.
Peters, J. P., et al:  Salt-Wasting Syndrome Associated With Cerebral Disease ,  Trans Assn Amer Physicians 63:57, 1950.
5.
Welt, L. G., et al:  Role of Central Nervous System in Metabolism of Electrolytes and Water ,  AMA Arch Int Med 90:355-378, 1952.Crossref
6.
Cort, J. H.:  Cerebral Salt Wasting ,  Lancet 1:752-754, 1954.Crossref
7.
Carter, N. W.; Rector, F. C., Jr.; and Seldin, D. W.:  Hyponatremia in Cerebral Disease Resulting From Inappropriate Secretion of Antidiuretic Hormone ,  New Eng J Med 264:67-72, 1961.Crossref
8.
Goldberg, M., and Handler, J. S.:  Hyponatremia and Renal Wasting of Sodium in Patients With Malfunction of Central Nervous System ,  New Eng J Med 263:1037-1043, 1960.Crossref
9.
Higgins, G., et al:  Metabolic Disorders in Head Injury: Survey of 76 Consecutive Cases ,  Lancet 1:61-67, 1954.Crossref
10.
Drachman, D., and Adams, R. D.:  Herpes Simplex and Acute Inclusion-Body Encephalitis ,  Arch Neurol 7:45-63, 1962.Crossref
11.
Greenfield, J. G., et al:  Herpes Simplex Encephalitis , Neuropathology, London: E. Arnold, Ltd., 1958, vol 643, 194.
12.
Haymaker, W.:  Herpes Simplex Encephalitis in Man: With Report of Three Cases ,  J Neuropath Exp Neurol 8:132-154, 1949.Crossref
13.
Burrows, B. A.; Hines, G. J.; and Ross, J. F.:  Simultaneous Determination of Radiosodium, Radiopotassium, and Radiosulphate Spaces ,  Clin Res Proceedings 2:81, 1954.
14.
Burrows, B. A., and Ross, J. F.:  Use of Radioactive Sodium and Potassium Tracer Studies in Man ,  Boston Med Quart 7:54-57, 1956.
15.
McCrory, W. W., and Macaulay, D.:  Idiopathic Hyponatremia in Infant With Diffuse Cerebral Damage ,  Pediatrics 20:23-32, 1957.
16.
Epstein, F. H., et al:  Cerebral Hyponatremia ,  New Eng J Med 265:513-518, 1961.Crossref
17.
Levinsky, N. G.; Davidson, D. G.; and Berliner, R. W.:  Changes in Urine Concentration During Prolonged Administration of Vasopressin and Water ,  Amer J Physiol 196:451-456, 1959.
18.
Bartter, F. C., et al:  Regulation of Aldosterone Secretion in Man: Role of Fluid Volume ,  J Clin Invest 35:1306-1315, 1956.Crossref
19.
Wise, B. L.:  Relation of Brain Stem to Renal Electrolyte Excretion ,  Proc Soc Exp Biol Med 91:557-560, 1956.Crossref
20.
Rapoport, S.; West, C. D., and Brodsky, W. A.:  Salt Losing Conditions: Renal Defect in Tuberculous Meningitis ,  J Lab Clin Med 37:550-561, 1951.
21.
Harrison, H. F.; Fineberg, L.; and Fleishman, E.:  Disturbances of Ionic Equilibrium of Intracellular and Extracellular Electrolytes in Patients With Tuberculous Meningitis ,  J Clin Invest 31:300-308, 1952.Crossref
22.
Fourman, P., and Leesan, P. M.:  Hypernatremia and Hyponatremia With Special Reference to Cerebral Disturbances , in Wolstenholme, G. E. W., ed.,  Ciba Foundation Colloquia on Aging: Water and Electrolyte Metabolism in Relation to Age and Sex , Boston: Little, Brown & Co., 1958, vol 3, p 36.
23.
Schwartz, W. B., et al:  Syndrome of Renal Sodium Loss and Hyponatremia Probably Resulting from Inappropriate Secretion of Antidiuretic Hormone ,  Amer J Med 23:529-542, 1957.Crossref
24.
Sims, E. A., et al:  Asymptomatic Hyponatremia in Pulmonary Tuberculosis ,  J Clin Invest 29:1545-1557, 1950.Crossref
25.
Schwartz, E., et al:  Unstable Osmolar Homeostasis With and Without Renal Sodium Wastage ,  Amer J Med 33:39-53, 1962.Crossref
26.
Dingman, J. E., et al:  Abnormal Neural Regulation of Vasopressin and Aldosterone Secretion in Patient With Cerebral Hyponatremia ,  J Clin Invest 41:1354, 1962.
27.
Roberts, J. H.:  Syndrome of Hyponatremia and Renal Sodium Loss Probably Resulting From Inappropriate Secretion of Antidiuretic Hormone ,  Ann Intern Med 51:1420-1426, 1959.Crossref
28.
Grumer, H. A., et al:  Idiopathic Episodic Inappropriate Secretion of Antidiuretic Hormone ,  Amer J Med 32:954-963, 1962.Crossref
29.
Zarafonetis, C. J. D., et al:  Fatal Herpes Simplex Encephalitis ,  Amer J Path 20:429-445, 1944.
30.
Whitman, L.; Wall, M. J.; and Warren, J.:  Herpes Simplex Encephalitis: Report of Two Fatal Cases ,  JAMA 131:1408-1411, 1946.Crossref
31.
Draheim, J. G., and de Rodaniche, E.:  Herpes Simplex Encephalitis: Report of Case ,  Amer J Clin Path 22:1077-1080, 1952.
32.
Brihaye, J.:  Étude des encephalites herpetiques et des encephalites necrosantes aigues ,  Acta Neurol Belg 59:1-114, 1959.
33.
Broca, P.:  Localisations cérébrales: Recherches sur les centres olfactifs ,  Rev Anthrop 8:385-455, 1879.
34.
Papez, J. W.:  Proposed Mechanism of Emotion ,  Arch Neurol Psychiat 38:725-743, 1937.Crossref
35.
MacLean, P. D.:  Some Psychiatric Implications of Physiological Studies on Fronto-Temporal Portion of. the Limbic System (Visceral Brain) ,  Electroenceph Clin Neurophysiol 4:407-418, 1952.Crossref
36.
MacLean, P. D., and Pribram, K. H.:  Neuronographic Analysis of Medial and Basal Cerebral Cortex in Cat ,  J Neurophysiol 16:312-323, 1953.
37.
Wall, P. D.; Glees, P.; and Fulton, J. F.:  Corticofugal Connections of Posterior Orbital Surface in Rhesus Monkey ,  Brain 74:66-71, 1951.Crossref
38.
Ward, A. A., and McCulloch, W. S.:  Projection of Frontal Lobe on Hypothalamus ,  J Neurophysiol 10:309-314, 1947.
39.
Bard, P., and Mountcastle, V. B.:  Some Forebrain Mechanisms Included in Expression of Rage With Special Reference to Suppression of Angry Behavior ,  Res Publ Assn Nerv Ment Dis 27:362-404, 1948.
40.
Gastaut, H.:  Correlations entre le systéme nerveux végétatif et le systéme de la vie de relation dans le rhinencephale ,  J Physiol (Paris) 44:431-470, 1952.
41.
Brady, J. B.: " Paleocortex and Behavioral Motivation ," in Harlow, H. F., and Woolsy, C. M., ed.:  Biological and Biological and Biochemical Basis of Behavior , Madison, Wis: Wisconsin Press, 1958, 476.
42.
Penfield, W., and Jasper, H. H.:  Epilepsy and Functional Anatomy of the Human Brain , Boston: Little, Brown & Co., 896, 1954.
43.
Rose, C. F., and Symonds, C. P.:  Persistent Memory Defect Following Encephalitis ,  Brain 83:195-212, 1960.Crossref
44.
Brodal, A.:  Hippocampus and Sense of Smell: Review ,  Brain 70:179-225, 1947.Crossref
45.
Clark, W. E., and Meyer, M.:  Anatomical Relationships Between Cerebral Cortex and Hypothalamus ,  Brit Med Bull 6:341-345, 1950.
46.
Nauta, W. J. H.:  Neural Associations of Amygdaloid Complex in Monkey ,  Brain 85:505-520, 1962.Crossref
47.
Gloor, P.: " Telencephalic Influence Upon Hypothalamus ," in Fields, W. S., ed.,  Hypothalamic-Hypophyseal Inter-Relationships , Springfield, Ill: Charles C Thomas, Publisher, 1956, pp 74-113.
48.
Schreiner, L., and Kling, A.:  Effects of Castration on Hypersexual Behavior Induced by Rhinencephalic Injury in Cat ,  AMA Arch Neurol Psychiat 72:180-186, 1954.Crossref
49.
Hess, W. R.; Akert, K.; and McDonald, D. A.:  Functions of Orbital Gyri of Cats ,  Brain 75:244-258, 1952.Crossref
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