MRI Deterioration in Herpes Simplex Encephalitis Despite Clinical Recovery

Departments of Neurology, University of Ioannina, Greece.
The Neurologist (Impact Factor: 1.16). 08/2009; 15(4):223-6. DOI: 10.1097/NRL.0b013e3181921abc
Source: PubMed


Herpes simplex virus type 1 is a sporadic cause of viral encephalitis. Relapse of encephalitis occurs in up to 10% of patients, manifested by recurrent symptoms, clinical and MRI findings, and the presence of herpes simplex virus type 1 DNA in the cerebrospinal fluid (CSF).
We describe the clinical features, MRI findings and outcome in 2 patients with herpes simplex encephalitis during the acute phase and 6 months after the onset of encephalitis.
Both patients had a good response to treatment and an excellent recovery. Despite clinical recovery, in a 6-month follow-up MRI lesions consistent with recurrence were disclosed, without any clinical findings or CSF abnormalities.
The mechanism underlying this MRI deterioration is unclear and an immune-mediated mechanism may be involved. Thus, MRI deterioration after herpes simplex encephalitis should be interpreted with caution and it does not always represent a relapse, especially when the imaging studies do not correlate with the clinical and CSF findings.

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    • "Relapse of HSV encephalitis occurs in up to 10%. In relapsing cases, there is clinical deterioration, neuropsychologic deficits, expansion of the lesions in MRI, and presence of viral replication or reactivation in the CSF proven by PCR for HSV type 1 DNA.8 We think in our case, the finding that the follow-up CSF HSV type 1 PCR became negative means it was not the relapse. "
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