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Herpes simplex virus infection limited to the brainstem
Matjaz Jereb1, Mitja Lainscak, Jozica Marin
1Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia. matjaz.jereb@kclj.si
Wiener Klinische Wochenschrift
|August 11, 2005
Summary
Herpes simplex virus encephalitis can rarely affect the brainstem, leading to fatal outcomes. Early empiric acyclovir treatment is crucial for unexplained encephalopathy to improve survival rates.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Herpes simplex virus (HSV) infection commonly causes focal meningoencephalitis, typically impacting the temporal or frontal lobes.
- Untreated HSV encephalitis has a high mortality rate of 70%.
Observation:
- A 46-year-old male presented with symptoms of aseptic meningitis, progressing to confusion, stupor, and coma.
- Cerebrospinal fluid analysis initially suggested aseptic meningitis, with later findings of low glucose. Initial PCR and CT scans were negative for HSV.
- Autopsy revealed hemorrhagic and necrotic brainstem meningoencephalitis, with HSV type 1 confirmed by in situ hybridization.
Findings:
- The patient died from HSV type 1 encephalitis specifically localized to the brainstem.
- Atypical presentation and negative initial diagnostic tests (PCR, CT) contributed to delayed diagnosis and mistreatment.
- Postmortem in situ hybridization confirmed HSV-1 nucleic acids in the brainstem.
Implications:
- This case highlights the importance of considering HSV encephalitis, even with atypical brainstem localization and negative initial tests.
- Delayed diagnosis and treatment of HSV encephalitis, particularly in unusual presentations, significantly worsen patient outcomes.
- Empiric acyclovir treatment is recommended for unexplained encephalopathy to mitigate the high mortality associated with HSV encephalitis.