Herpes simplex encephalitis

Case contributed by RMH Core Conditions

Presentation

Two days of headache followed by GTCS.

Patient Data

Age: 65
Gender: Male
Modality: MRI

High signal FLAIR / T2 signal is demonstrated within the right mesial temporal lobe associated with mild gyral expansion, sulcal effacement and restricted diffusion.

Equivocal high FLAIR/T2 signal is also seen at the left mesial temporal lobe, with lesser positive mass effect, and no convincing restricted diffusion.

Apart from a few scattered white matter high foci, the remainder of the examination is within normal limits. No hydrocephalus. No susceptibility artefact.

Conclusion:

Given the history of fever and seizures coupled with the MRI findings of bilateral mesial temporal lobe changes, herpes encephalitis requires clinical consideration.

Differentials include post-ictal changes, with other differentials such as neoplastic causes thought less likely.

Case Discussion

Patient proceeded to lumbar puncture and on PCR, HSV-1 DNA was detected. Patient was immunosuppressed for a renal transplant. 

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Case Information

rID: 34113
Case created: 4th Feb 2015
Last edited: 9th Feb 2016
Inclusion in quiz mode: Included

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