Herpes simplex encephalitis

Case contributed by Dr Abdallah Khateeb

Presentation

A young adult male presenting with fever and headaches. No focal neurological symptoms.

Patient Data

Age: 33-year-old
Gender: Male
CT

Brain NECT

The CT scan shows subtle hypodensity at the medial inferior part of the left temporal lobe. 

Please keep in mind that a normal CT scan does not rule out the diagnosis.

MRI

Enhanced brain MRI

The left temporal lobe shows obvious T2 and FLAIR high signal at the cortex and corresponding diffusion restriction due to cytotoxic edema, along with gyriform and leptomeningeal patterns of enhancement.
The right side also shows similar but less advanced changes.

No areas of necrosis or foci of hemorrhage seen.

Case Discussion

Herpes encephalitis is a serious, potentially life-limiting illness.
Since the presentation is usually non-specific, proper imaging is helpful in suggesting this diagnosis, thus guiding the clinician to do a lumbar puncture, or even start empiric therapy. 

This patient underwent LP which confirmed herpes encephalitis via PCR.

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Case information

rID: 43290
Case created: 3rd Mar 2016
Last edited: 29th Jun 2017
Inclusion in quiz mode: Included

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