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Herpes encephalitis preceded by ipsilateral vestibular neuronitis.

Stephen J Philpot1, John S Archer

  • 1Department of Neurology, Cairns Base Hospital and James Cook University, Cairns, Queensland, Australia.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|October 26, 2005
PubMed
Summary

Herpes simplex virus type 1 (HSV-1) can cause vestibular neuronitis, leading to vertigo. In rare cases, this infection may progress to herpes simplex encephalitis, affecting the temporal lobe.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Otolaryngology

Background:

  • Vestibular neuronitis is an acute vestibular syndrome often of viral etiology.
  • Herpes simplex virus type 1 (HSV-1) is a common cause of sporadic encephalitis.

Observation:

  • A 74-year-old woman presented with acute vertigo and leftward nystagmus.
  • Cerebral imaging was initially normal.
  • Three days later, she developed fever, altered mental status, and left medial temporal lobe hypodensity.

Findings:

  • Lumbar puncture confirmed herpes simplex type 1 encephalitis.
  • The clinical presentation suggests an initial diagnosis of vestibular neuronitis caused by HSV-1.
  • The encephalitis developed ipsilaterally to the initial vestibular symptoms.

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Implications:

  • This case suggests HSV-1 as a potential cause of vestibular neuronitis.
  • It highlights the possibility of HSV-1 progression from vestibular involvement to temporal lobe encephalitis.
  • Early recognition and treatment are crucial for managing HSV-1 encephalitis.