HSV encephalitis

Case contributed by Dr Laughlin Dawes

Presentation

This 33 year-old female patient presented with agitation, confusion, mutism, and fever.

Patient Data

Age: 33 yrs
Gender: Female
MRI

This coronal T2WI MR image shows high signal in the temporal lobes including hippocampal formations and parahippogampal gyrae, insulae, and right inferior frontal gyrus. The right gyrus rectus and the columns of the fornices were also involved (not shown). There was no associated haemorrhage or enhancement. There was moderate mass-effect.

Case Discussion

Lumbar puncture was performed - herpes simplex virus DNA was not shown on polymerase chain reaction. A brain biopsy was performed and the histology was consistent with encephalitis. PCR was repeated on the biopsy specimen and was positive for HSV type I.

HSV encephalitis typically produces abnormal signal +/- enhancement in the limbic system and temporal lobes. It is usually bilateral but asymmetrical. The basal ganglia are usually spared. The differential diagnoses include limbic encephalitis (paraneoplastic), gliomatosis cerebri, and status epilepticus. HSV-1 causes 95% of all herpetic encephalitides. Mortality ranges from 50-70%, and treatment is with intravenous antivirals.

 

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Case information

rID: 3444
Case created: 22nd May 2008
Last edited: 31st Oct 2015
Inclusion in quiz mode: Included

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