Herpes simplex encephalitis

Case contributed by Dr Husam Hussein Yaseen

Presentation

Headache and fever for 4 days.

Patient Data

Age: 13 years
Gender: Female
CT

There is an ill-defined hypodense area involving the anteromedial portion of the left temporal lobe, both sylvian cortex, and the left frontal lobe. A small hyperdense focus has seen in the left sylvian cortex representing small hemorrhage.

MRI

There is gyral swelling involving the left temporal lobe, sylvian cortex, and frontal lobe. Some gyral swelling is also noted on the right, although to a lesser degree. A focus of hemorrhage is seen on the left sylvian cortex. The basal ganglia are spared on both sides.No significant parenchymal enhancement in the post-contrast study although patchy meningeal enhancement is seen.

Case Discussion

A teenage female admitted to the emergency room complaining of headache and fever for 4 days, then she had vomiting, poor appetite and decrease cognitive function. The patient was examined and was found to have positive meningeal signs. CT was performed immediately thereafter and MRI was performed the following day. The patient received antiviral medication (Acyclovir) on the same day of admission that continued for two weeks then she was discharged after recovery. 

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Case information

rID: 73059
Published: 23rd Dec 2019
Last edited: 24th Dec 2019
Inclusion in quiz mode: Included

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