Herpes simplex encephalitis in a patient with complex partial epilepsy: confirmation by the polymerase chain

The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). Links to PubMed are also available for Selected References. The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). MELAS syndrome in adults may present as an atypical, recurrent form of HSE and should be added to the list of neurologic diseases that can mimic HSE. Nevertheless, HSV can result in disease of the central nervous system (CNS) with attendant neurological complications.

It provided an alternative diagnosis in four patients, for two of whom curative treatment was available. The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). This improvement was achieved without evidence of acute drug toxicity. Bell’s palsy is yet another manifestation of a herpes virus infection in at least some reported cases documented by CSF analysis. The development of the first successful therapies for a life-threatening viral infection ranks with the introduction of sulfonamides and penicillin for the treatment of bacterial infections. Methods: CSF from patients with was tested for human herpesviruses types 1–6, JC virus, enteroviruses, and Toxoplasma gondii.


Because syphilis is not routinely tested for, awareness of this mimicry of herpes simplex virus encephalitis is important, considering the potential therapeutic implications. The guideline includes data on the epidemiology, clinical features, diagnosis, and treatment of many viral, bacterial, fungal, protozoal, and helminthic etiologies of encephalitis and provides information on when specific etiologic agents should be considered in individual patients with encephalitis. Initial therapy with vancomycin, ceftriaxone and acyclovir was administered. Wityk), Division of Neurology, Sinai Hospital of Baltimore, Baltimore, MD. Nevertheless, HSV can result in disease of the central nervous system (CNS) with attendant neurological complications. Methods: CSF from patients with was tested for human herpesviruses types 1–6, JC virus, enteroviruses, and Toxoplasma gondii.

Methods: A non-randomised retrospective study of 45 patients with HSVE treated with aciclovir was conducted. Further complicating laboratory diagnosis, an endogenous murine coronavirus was isolated from newborn mice inoculated with the patient’s brain biopsy tissue. Initial brain MRI showed left temporal lobe hyperintensity, and cerebrospinal fluid cytology revealed a mild pleocytosis. CSF PCR is rapid, inexpensive, and only minimally invasive. Epidemiologic and clinical information collected for each case guided further testing. Acute disseminated encephalomyelitis is a demyelinating disease, typically occurring in children following a febrile infection or a vaccination.

After a diagnosis was made, the case notes and neuroradiology (where available) were reviewed and a limited follow-up was undertaken. Evaluation of this hypothesis has been impeded by the lack of an immunologically defined animal model that resembles the human disease. Case report. Acyclovir is a relatively safe, effective antiviral agent with little toxicity as currently used to treat HSE. The diagnosis was confirmed by detection of herpes simplex virus type 2 (HSV 2), but not type 1, DNA in cell-free cerebrospinal fluid (CSF) after amplification by nested polymerase chain reaction. The pace of discovery has continued in recent years with the development of more rapid DNA amplification techniques that do not require postamplification analysis using amplified products (real-time PCR).

The case illustrates the importance of actively excluding organic causes in such patients, the need to have a low threshold of suspicion for HSV encephalitis, and the central role of CSF PCR testing for the diagnosis of HSV encephalitis, even in the absence of CSF biochemical abnormalities. We reviewed all adult cases of encephalitis with TL abnormalities on magnetic resonance imaging (MRI) from the California Encephalitis Project. MRI of the brain showed cortical and subcortical lesions in the mesial temporal region, septal area, insula and cingulated gyrus of the right cerebral hemisphere. A simple restriction enzyme analysis of these amplified products allowed accurate characterization of the herpesvirus type. Address correspondence to H.G. A 21-year-old male with SLE developed seizure, loss of consciousness and focal signs referable to involvement of the front-temporal brain regions.