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[Herpes simplex encephalitis originating from bilateral thalamic lesions with hemorrhagic component]
Jiro Sakaguchi1, Kiminobu Yonemura, Yoichiro Hashimoto
1Department of Strokology, Kumamoto City Hospital.
Rinsho Shinkeigaku = Clinical Neurology
|June 18, 2005
Summary
This case highlights unusual thalamic lesions in herpes simplex encephalitis (HSE). Early recognition and treatment of HSE, even with atypical presentations, are crucial for patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimaging
Background:
- Herpes simplex encephalitis (HSE) is a severe neurological infection.
- Thalamic involvement in HSE is uncommon, often presenting with more diffuse or limbic system lesions.
Observation:
- A 71-year-old woman presented with fever, headache, and neurological deficits.
- Initial CT revealed right thalamic hemorrhage, with MRI showing bilateral thalamic T2-hyperintense lesions.
- Cerebrospinal fluid (CSF) showed no pleocytosis initially, but PCR later confirmed herpes simplex virus.
Findings:
- Lesions expanded to medial temporal lobes, amygdala, hippocampus, and insular cortex by day five.
- Diagnosis of HSE was confirmed via PCR on CSF.
- Patient showed gradual recovery after prompt treatment with acyclovir and ara-A.
Implications:
- This case suggests that the thalamus can be a primary site for HSE lesions.
- Clinicians should consider HSE in cases with thalamic abnormalities, even without initial CSF pleocytosis.
- Early diagnosis and intervention are vital for improving prognosis in atypical HSE presentations.