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Journal of Education, Health and Sport

HSV encephalitis with normal initial CT scan - a case report with a review of the literature
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  • HSV encephalitis with normal initial CT scan - a case report with a review of the literature
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HSV encephalitis with normal initial CT scan - a case report with a review of the literature

Authors

  • Marcin Kulczyński Chair and Department of Neurology, Medical University of Lublin
  • Małgorzata Abramczyk Department of Radiology, 1st Military Clinical Hospital with the Outpatient Clinic, Lublin
  • Klaudia Sapko Chair and Department of Neurology, Medical University of Lublin
  • Michał Marciniec Chair and Department of Neurology, Medical University of Lublin
  • Przemysław Dyndor Chair and Department of Rehabilitation and Orthopaedics, Medical University of Lublin
  • Katarzyna Dyndor Department of Radiography, Medical University of Lublin

DOI:

https://doi.org/10.12775/JEHS.2020.10.09.106

Keywords

herpes simplex virus, magnetic resonance imaging, encephalitis, cerebrospinal fluid

Abstract

Introduction. HSV-1 is the most common cause of viral encephalitis with a high mortality rate if left untreated and causes frequent diagnostic difficulties. It commonly involves the temporal, inferior frontal lobes and the limbic system. HSV can be differentiated by a combination of symptoms, laboratory tests and neuroimaging findings.

Case report. A 29-year old female with HSV encephalitis, who, despite prevailing symptoms of altered mental status, had no abnormalities on initial CT head scan. Three MRI follow-up examinations revealed imaging findings with characteristic evolution. Despite CSF results being negative for HSV antibodies, the combination of symptoms, CSF analysis, and characteristic MRI findings were highly suggestive to diagnosing HSV encephalitis and to implement proper treatment.

Discussion. In case of radiological changes in temporal lobe, the involvement of the Herpes simplex encephalitis (HSE) should always be considered. Although the laboratory tests happen to be inconclusive or even falsely negative, neuroimaging often helps to determine the diagnosis. Despite HSE being a severe neurological disorder, initial CT scans can be normal. MRI has become superior, especially at the early phase of the disease and is capable of determining the extensiveness of lesions.

References

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Jayaraman K, Rangasami R, Chandrasekharan A. Magnetic Resonance Imaging Findings in Viral Encephalitis: A Pictorial Essay. J Neurosci Rural Pract. 2018 Oct-Dec;9(4):556-560. doi: 10.4103/jnrp.jnrp_120_18. PMID: 30271050; PMCID: PMC6126294.

Bradshaw MJ, Venkatesan A. Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management. Neurotherapeutics. 2016 Jul;13(3):493-508. doi: 10.1007/s13311-016-0433-7. PMID: 27106239; PMCID: PMC4965403.

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Stahl JP, Mailles A. Herpes simplex virus encephalitis update. Curr Opin Infect Dis. 2019 Jun;32(3):239-243. doi: 10.1097/QCO.0000000000000554. PMID: 30921087.

Granerod J, Davies NW, Mukonoweshuro W, Mehta A, Das K, Lim M, Solomon T, Biswas S, Rosella L, Brown DW, Crowcroft NS; UK Public Health England Aetiology of Encephalitis Study Group. Neuroimaging in encephalitis: analysis of imaging findings and interobserver agreement. Clin Radiol. 2016 Oct;71(10):1050-8. doi: 10.1016/j.crad.2016.03.015. Epub 2016 May 13. PMID: 27185323; PMCID: PMC5021199.

Chow FC, Glaser CA, Sheriff H, Xia D, Messenger S, Whitley R, Venkatesan A. Use of clinical and neuroimaging characteristics to distinguish temporal lobe herpes simplex encephalitis from its mimics. Clin Infect Dis. 2015 May 1;60(9):1377-83. doi: 10.1093/cid/civ051. Epub 2015 Jan 30. PMID: 25637586; PMCID: PMC4462661.

McCabe K, Tyler K, Tanabe J. Diffusion-weighted MRI abnormalities as a clue to the diagnosis of herpes simplex encephalitis. Neurology. 2003 Oct 14;61(7):1015-6. doi: 10.1212/01.wnl.0000082387.97051.f5. PMID: 14557588.

Renard D, Nerrant E, Lechiche C. DWI and FLAIR imaging in herpes simplex encephalitis: a comparative and topographical analysis. J Neurol. 2015 Sep;262(9):2101-5. doi: 10.1007/s00415-015-7818-0. Epub 2015 Jun 20. PMID: 26092520.

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Published

2020-09-28

How to Cite

1.
KULCZYŃSKI, Marcin, ABRAMCZYK, Małgorzata, SAPKO, Klaudia, MARCINIEC, Michał, DYNDOR, Przemysław and DYNDOR, Katarzyna. HSV encephalitis with normal initial CT scan - a case report with a review of the literature. Journal of Education, Health and Sport. Online. 28 September 2020. Vol. 10, no. 9, pp. 877-881. [Accessed 6 July 2025]. DOI 10.12775/JEHS.2020.10.09.106.
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Issue

Vol. 10 No. 9 (2020)

Section

Case Reports

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