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Related Experiment Videos

Atypical herpes simplex encephalitis presenting as operculum syndrome.

R W Wolf1, D Schultze, C Fretz

  • 1Institut für Radiologie, Kantonsspital St. Gallen, Switzerland.

Pediatric Radiology
|April 14, 1999
PubMed
Summary
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Herpes simplex virus cerebritis in a child presented with seizures and operculum syndrome. Diagnosis was confirmed by MRI and oligoclonal antibodies, despite a negative PCR test.

Area of Science:

  • Neurology
  • Pediatric Neurology
  • Infectious Diseases

Background:

  • Herpes simplex virus (HSV) cerebritis is a rare but severe neurological infection.
  • Early diagnosis and treatment are crucial for favorable outcomes in pediatric patients.

Observation:

  • A 7-year-old child presented with non-specific symptoms and an epileptic attack.
  • Magnetic resonance imaging revealed subcortical, bilateral opercular, and thalamic lesions, sparing temporal and frontal lobes.
  • The patient developed anarthria and impaired mastication/swallowing, indicative of operculum syndrome.

Findings:

  • Cerebrospinal fluid analysis showed elevated oligoclonal antibodies specific to HSV.
  • Polymerase chain reaction (PCR) testing for HSV in CSF was unexpectedly negative.

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  • The combination of clinical presentation, neuroimaging, and specific antibody detection confirmed the diagnosis.

    • Implications:

    • This case highlights the importance of considering HSV cerebritis even with negative PCR results.
    • Oligoclonal antibodies in CSF can be a valuable diagnostic marker for HSV encephalitis.
    • Understanding atypical presentations aids in timely diagnosis and management of pediatric HSV infections.