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Herpes simplex encephalitis--an atypical case.

B Razavi1, M Razavi

  • 1Division of Infectious Diseases, Washington University, St. Louis, MO 63110, USA. behzadr@hotmail.com

Infection
|January 15, 2002
PubMed
Summary

Herpes simplex encephalitis (HSE) can present with normal initial cerebrospinal fluid (CSF) findings, delaying diagnosis. Early consideration of HSE in encephalopathic patients is crucial, even with a normal CSF analysis, to prevent severe outcomes.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Virology

Background:

  • Herpes simplex virus (HSV) is a frequent cause of viral encephalitis.
  • Herpes simplex encephalitis (HSE) typically manifests with acute neurological changes.
  • Cerebrospinal fluid (CSF) analysis is almost invariably abnormal in typical HSE presentations.

Observation:

  • This report details a case of HSE in a patient with an initially normal CSF examination.
  • The normal initial CSF analysis contributed to a delay in diagnosis and treatment.
  • This delay led to severe neurological sequelae in the patient.

Findings:

  • A normal initial CSF examination does not exclude the possibility of Herpes simplex encephalitis.
  • Delayed diagnosis of HSE can result in significant and potentially irreversible neurological damage.

Implications:

  • Herpes simplex infection must be considered in the differential diagnosis of encephalopathic patients, irrespective of CSF findings.
  • Clinicians should maintain a high index of suspicion for HSE even when initial CSF results are unremarkable.
  • Prompt recognition and treatment of HSE are essential to mitigate severe neurological sequelae.

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