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Imaging and laboratory investigation in herpes simplex encephalitis
M E Coren1, R M Buchdahl, F M Cowan
1Department of Paediatrics, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middx UB8 3NN, UK.
Journal of Neurology, Neurosurgery, and Psychiatry
|July 17, 1999
Summary
Herpes simplex encephalitis (HSE) in a neonate was initially missed due to a negative PCR test. Sequential cerebrospinal fluid (CSF) analysis confirmed the diagnosis, highlighting its importance in pediatric neurology.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroimaging
Background:
- Herpes simplex encephalitis (HSE) is a severe neurological condition in infants.
- Early diagnosis and treatment are crucial for patient outcomes.
- Standard diagnostic methods may sometimes yield inconclusive initial results.
Observation:
- A 14-day-old infant presented with acute encephalitis symptoms.
- Initial magnetic resonance imaging (MRI) and electroencephalogram (EEG) were normal.
- A negative polymerase chain reaction (PCR) test on cerebrospinal fluid (CSF) initially suggested HSE was unlikely.
Findings:
- Despite initial negative PCR, specific antibody production in CSF confirmed HSE via immunoelectrophoresis.
- The infant sustained extensive brain tissue damage.
- Rapid clinical improvement was observed.
Implications:
- This case underscores the critical need for sequential CSF analysis in diagnosing HSE, especially in neonates.
- Negative initial PCR results should not preclude further investigation for HSE.
- Timely and accurate diagnosis, even with challenging initial results, is vital for managing severe pediatric neurological conditions.