Short report
Micturitional disturbance in herpetic brainstem encephalitis;
contribution of the pontine micturition centre
a Department of Neurology, b Department of
Urology, Chiba University School of Medicine, Chiba, Japan, c Department of Neurology, Kashima
Rosai Hospital, Kashima, Japan
Correspondence to: Dr R Sakakibara, Department of Neurology, Chiba University 1-8-1 Inohana, Chuo-Ku, Chiba 260 Japan. Telephone 0081 43 226 2129; fax 0081 43 226 2160; email sakaki{at}med.m.chiba-u.ac.jp
Received 30 May 1997;
Accepted 9 July 1997
Micturitional disturbance is rarely mentioned in human herpetic
brainstem encephalitis although the pontine tegmentum, called the
pontine micturition centre, seems to regulate the lower urinary tract
in experimental animals. The case of a 45 year old man, who developed
subacute coma and hiccup-like dysrhythmic breathing, and needed
assisted ventilation is reported. Examination of CSF showed mononuclear
pleocytosis and antibody against herpes simplex virus type 1, but the
opening pressure was 90 cm H2O. Brain CT showed brain
swelling, predominantly in the posterior fossa, and bilateral subdural
effusion. Herpetic brainstem encephalitis was diagnosed, and he
received 900 mg/day vidarabine. On regaining consciousness, he had left
trochlear nerve palsy, left corectopia, ageusia, and urinary retention.
Brain MRI showed right side dominant, bilateral pontine segmental
lesions extending slightly to the midbrain and medulla. After two weeks
he was able to urinate but showed nocturnal urinary frequency, urinary
incontinence, and voiding difficulty. Urodynamic studies showed a
residual urine volume of 350 ml and detrusor hyporeflexia on voiding.
Micturitional disturbance gradually disappeared together with the
neurological signs. The bilateral pontine tegmental lesions in this
patient are similar to those in previous findings on brainstem strokes, evidence of the presence of a pontine micturition centre
in humans.
© 1998 by Journal of Neurology, Neurosurgery, and Psychiatry
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