Magnetic resonance imaging and computerized tomography scanning of herpes simplex encephalitis (original) (raw)
Journal of the Neurological Sciences, 1998
The early diagnosis of herpes simplex encephalitis (HSE) is essential because early introduction of antiviral therapy can significantly reduce the mortality of this disease. Herpes simplex virus (HSV) DNA detection in cerebrospinal fluid (CSF) samples is a rapid, noninvasive, specific, and highly sensitive method for HSE diagnosis. Neurodiagnostic methods have also been studied for noninvasive diagnosis of HSE. Magnetic resonance imaging (MRI) seems to be the most sensitive of them but it has not been compared to PCR in terms of efficacy for HSE diagnosis. In this study, 17 patients with focal encephalitis were prospectively evaluated by PCR analysis of CSF samples and MRI examination. MRI lesions involving the inferomedial region of one or both temporal lobes were observed in all PCR-positive patients but one. No PCR-negative patient presented with the same pattern of MRI lesions. MRI was also important for the establishment of an alternative diagnosis in three of eight PCR-negative patients. Both methods should be routinely applied in the evaluation of presumed HSE cases.
MRI Deterioration in Herpes Simplex Encephalitis Despite Clinical Recovery
The Neurologist, 2009
Objectives: Herpes simplex virus type 1 is a sporadic cause of viral encephalitis. Relapse of encephalitis occurs in up to 10% of patients, manifested by recurrent symptoms, clinical and MRI findings, and the presence of herpes simplex virus type 1 DNA in the cerebrospinal fluid (CSF). Methods: We describe the clinical features, MRI findings and outcome in 2 patients with herpes simplex encephalitis during the acute phase and 6 months after the onset of encephalitis. Results: Both patients had a good response to treatment and an excellent recovery. Despite clinical recovery, in a 6-month follow-up MRI lesions consistent with recurrence were disclosed, without any clinical findings or CSF abnormalities. Conclusions: The mechanism underlying this MRI deterioration is unclear and an immune-mediated mechanism may be involved. Thus, MRI deterioration after herpes simplex encephalitis should be interpreted with caution and it does not always represent a relapse, especially when the imaging studies do not correlate with the clinical and CSF findings.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015
We describe the spectrum of etiologies associated with temporal lobe (TL) encephalitis and identify clinical and radiologic features that distinguish herpes simplex encephalitis (HSE) from its mimics. We reviewed all adult cases of encephalitis with TL abnormalities on magnetic resonance imaging (MRI) from the California Encephalitis Project. We evaluated the association between specific clinical and MRI characteristics and HSE compared with other causes of TL encephalitis and used multivariate logistic modeling to identify radiologic predictors of HSE. Of 251 cases of TL encephalitis, 43% had an infectious etiology compared with 16% with a noninfectious etiology. Of infectious etiologies, herpes simplex virus was the most commonly identified agent (n = 60), followed by tuberculosis (n = 8) and varicella zoster virus (n = 7). Of noninfectious etiologies, more than half (n = 21) were due to autoimmune disease. Patients with HSE were older (56.8 vs 50.2 years; P = .012), more likel...
Extra-temporal involvement in herpes simplex encephalitis
Journal of Clinical Neuroscience, 2010
Temporal lobe abnormalities on brain imaging have been described as strong evidence for herpes simplex encephalitis (HSE) in appropriate clinical settings. Extra temporal abnormalities are less well described in these patients. We retrospectively reviewed 20 patients of HSE and found extra temporal involvement in 11 (55%) patients. Three patients (15 %) had pure extra temporal abnormalities. Twelve patients (60%) had temporal lobe involvement, four patients (20%) had pure temporal lobe involvement and five patients (25%) had normal CT/MRI scans. Our study suggests that extra temporal involvement on brain imaging is common in HSE and in a significant minority of the patients this can even be the sole abnormality.
Herpes simplex virus encephalitis: A literature review
Romanian Journal of Neurology
HSVE (Herpes simplex virus encephalitis) is an infection caused by herpes simplex virus type 1 (HSV-1) or type 2 that produces neurologic problems. HSVE is associated with significant morbidity and mortality in adults even with antiviral medication, and it is a fatal disease in babies and children regardless of treatment. The most likely pathways include retrograde transmission through the olfactory or trigeminal nerves, as well as hematogenous spread. The most common presenting symptoms are encephalopathy, fever, convulsions, headache, and regional neurologic dysfunction. An accurate history and physical examination are required to identify Herpes simplex virus encephalitis (HSVE), and a prompt assessment is advised after the diagnosis has been established. HSVE is a neurodegenerative disease that may be fatal. Rapid diagnostic work-up and early diagnosis in all suspected or confirmed cases will result in early initiation of intravenous acyclovir, which may decrease morbidity and d...
SAGE Open Medical Case Reports
Headaches in children are a common, but unspecific symptom that can have many underlying causes, ranging from unspecific tension headache through migraine and up to encephalitis and intracranial hypertension. We present the case of a 14-year-old boy who presented to our emergency department with headache, nausea as well as vomiting and developed seizures later on. The initial diagnosis was complicated by a magnetic resonance imaging which did not show any signs of inflammation, but was of limited informative value due to orthodontic appliances. Despite the unremarkable imaging, prophylactic antiviral and antibiotic treatment was started after lumbar puncture. Herpes simplex virus as well as human herpes virus 7 were confirmed in the cerebrospinal fluid. Although both viruses are ubiquitous, severe infections are a rare complication. Immunodeficiency syndromes are predisposing factors for serious complications and genetic analysis of UNC93B and TLR-3 might be helpful for decision-mak...
Subacute presentation of herpes simplex virus-1 encephalitis: A rare case report
Journal of Medical Society, 2018
Herpes simplex virus 1 is a prevalent neurotropic pathogen that infects and establishes latency in peripheral sensory neurons. It can migrate into the central nervous system and cause encephalitis. e association between herpes simplex virus encephalitis and cerebral venous thrombosis is rare, with a very limited number of case reports described in the literature, despite the recognized thrombogenic effects of the virus. A 44-year-old man was brought to the emergency department with generalized tonic-clonic seizures requiring sedation and ventilation to control it. Initial brain computed tomography revealed cortical and subcortical edema on the left frontal lobe, and a subsequent contrast-enhanced exam showed absence of venous flow over the anterior half of the superior sagittal sinus. Cerebrospinal fluid polymerase chain reaction was positive for herpes simplex virus type 1, and the patient was started on acyclovir and anticoagulation, with clinical improvement. Acyclovir administration was maintained for 14 days and oral anticoagulation for one year, with no recurrence of thrombotic events or other complications. A well-timed treatment has a validated prognostic impact on herpes simplex encephalitis, making early recognition of its clinical aspects of main importance.