Herpetic encephalitis

Case contributed by Dr Bruno Di Muzio

Presentation

Fever associated with mental confusion, behavioural changes, impaired speech and reduced level of consciousness.

Patient Data

Age: 31
Gender: Male

MRI Brain

Modality: MRI

T2 and FLAIR shows high signal in the left temporal lobe including hippocampal formation and parahippogampal gyrus as well on bilateral insulae gyrus (Involvement is bilateral but asymmetrical). There is slight thickening and meningeal enhancement on left temporal lobe. 

Case Discussion

Herpes simplex encephalitis is the most common cause of fatal sporadic viral encephalitis and has characteristic imaging findings. Although these abnormalities seen in HSV encephalitis are not unique, more than 90% of patients with proven HSV encephalitis will have magnetic resonance imaging abnormalities involving the temporal lobes. 

The patient was transferred from another hospital already being treated with acyclovir. Lumbar puncture shows CSF pleocytosis, but HSV PCR was negative (false negative?). 

Negative CSF HSV PCR results should always be interpreted in the context of the timing of specimen collection and the likelihood of disease. 

Clinical improvement occurred with treatment. 

The diagnosis is presumptive.

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Case Information

rID: 26529
Case created: 26th Dec 2013
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

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