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Herpes Simplex Encephalitis

Published online by Cambridge University Press:  02 December 2014

Sean W. Taylor ,
Roger M. Smith ,
Giovanna Pari ,
Wendy Wobeser ,
John P. Rossiter  and
Alan C. Jackson
Sean W. Taylor
Affiliation:
Department of Medicine (Neurology), Queen's University, Kingston, Ontario, Canada
Roger M. Smith
Affiliation:
Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
Giovanna Pari
Affiliation:
Department of Medicine (Neurology), Queen's University, Kingston, Ontario, Canada
Wendy Wobeser
Affiliation:
Department of Infectious Diseases, Queen's University, Kingston, Ontario, Canada
John P. Rossiter
Affiliation:
Department of Pathology, Queen's University, Kingston, Ontario, Canada
Alan C. Jackson
Affiliation:
Department of Medicine (Neurology), Queen's University, Kingston, Ontario, Canada
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A 28-year-old woman presented with a one day history of high fever and partial seizures with secondary generalization. This was preceded by a three week history of headache, ataxia, and fatigue. An initial computed tomogram head scan showed a low density mass lesion in the right frontal operculum without enhancement. On the next day, a repeat scan showed a new frontopolar, expansile, low density cortical lesion (Figure 1A) suggestive of encephalitis. Cerebrospinal fluid showed a pleocytosis of 311 mononuclear white blood cell count per μL and an elevated protein of 1.57 g/L. She received intravenous acyclovir and antibiotics. She remained febrile and became mute. A magnetic resonance (MR) scan under general anesthesia on her fourth hospital day showed frontal and perisylvian lesions with restricted diffusion (Figure 1B - D and Figure 2). A right frontal brain biopsy showed meningoencephalitis and immunohistochemical staining was positive for herpes simplex virus (HSV) antigen (Figure 3). Subsequently, HSV-1 DNA was demonstrated in both cerebrospinal fluid and brain tissue with polymerase chain amplification. She improved after a course of intravenous therapy with acyclovir with residual frontal lobe signs, including marked executive dysfunction, and her speech became normal.

Type
Neuroimaging Highlights
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 2 , May 2005 , pp. 246 - 247
Copyright
Copyright © The Canadian Journal of Neurological 2005

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