HSV encephalitis

Case contributed by Dr Hani Salam

Presentation

20 month old male patient with history of fever and seizure.

Patient Data

Age: 20 months
Gender: Male
Modality: CT

Single non-contrast CT image demonstrates low density in the right temporal lobe and bilateral inferior occipital / posterior temporal lobes. 

Modality: MRI

Single axial FLAIR image demonstrating high T2 signal in the temporal and occipital lobe white matter. 

CSF analysis showed:

  • CSF WBC 82 (0-20%)
  • CSF LYMPHS 80 (40-80%)

The rest of parameters were within normal.

HSV-PCR was positive.

2 months later

Modality: CT

Single non-contrast CT image 2 months later demonstrates low density and volume loss consistent with encephalomalacia. 

2 months later

Modality: MRI

Single axial FLAIR image 2 months later demonstrating striking bilateral encephalomalacia. 

Case Discussion

Although HSV encephalitis in adults typically involves the medial temporal lobes, extensive involvement elsewhere (extra-limbic) is more common in children as is subsequent encephalomalacia is also encountered. 

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Case Information

rID: 7780
Case created: 6th Dec 2009
Last edited: 27th Nov 2015
Inclusion in quiz mode: Excluded

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