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.