HSV encephalitis
Diagnosis certain
Updates to Case Attributes
Presentation
was changed:
Agitation, confusion, mutism, and fever.
Body
was changed:
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.
-<p>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.</p><p><a href="/articles/herpes-simplex-encephalitis">HSV encephalitis</a> 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 <a href="/articles/limbic-encephalitis">limbic encephalitis</a> (paraneoplastic), <a href="/articles/gliomatosis-cerebri">gliomatosis cerebri</a>, and <a href="/articles/status-epilepticus">status epilepticus</a>. HSV-1 causes 95% of all herpetic encephalitides. Mortality ranges from 50-70%, and treatment is with intravenous antivirals.</p><p> </p>- +<p><a title="Lumbar puncture" href="/articles/lumbar-puncture">Lumbar puncture</a> was performed - herpes simplex virus DNA was not shown on <a title="polymerase chain reaction" href="/articles/polymerase-chain-reaction">polymerase chain reaction</a>. 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.</p><p><a href="/articles/herpes-simplex-encephalitis">HSV encephalitis</a> typically produces abnormal signal +/- enhancement in the <a title="Limbic system" href="/articles/limbic-system">limbic system</a> and temporal lobes. It is usually bilateral but asymmetrical. The basal ganglia are usually spared. The differential diagnoses include <a href="/articles/autoimmune-encephalitis">limbic encephalitis</a> (paraneoplastic), <a href="/articles/gliomatosis-cerebri">gliomatosis cerebri</a>, and <a href="/articles/status-epilepticus">status epilepticus</a>. HSV-1 causes 95% of all <a title="Encephalitis due to herpesvirus family" href="/articles/encephalitis-due-to-herpesvirus-family">herpetic encephalitides</a>. Mortality ranges from 50-70%, and treatment is with intravenous antivirals.</p>
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