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State of the Art Cranial Ultrasound Imaging in Neonates
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Imaging findings of neonatal herpes simplex virus type 2 encephalitis

Arastoo Vossough1, Robert A Zimmerman, Larissa T Bilaniuk

  • 1Children's Hospital of Philadelphia, University of Pennsylvania, 34th and Civic Center Blvd., Philadelphia, PA 119104, USA. vossough@email.chop.edu

Neuroradiology
|February 5, 2008
PubMed

Insights

Diffusion-weighted MRI significantly improves the diagnosis of neonatal herpes simplex virus type 2 (HSV-2) encephalitis by revealing lesions not visible on conventional imaging. This advanced technique is crucial for understanding the variable imaging appearance of this serious neonatal infection.

Area of Science:

  • Neurology
  • Pediatric Infectious Diseases
  • Radiology

Background:

  • Neonatal herpes simplex virus type 2 (HSV-2) encephalitis is a severe infection with potentially variable initial imaging findings.
  • Early diagnosis and understanding of disease patterns are critical for effective management.

Purpose of the Study:

  • To assess initial and follow-up imaging findings using CT, MRI, and diffusion-weighted imaging (DWI) in neonatal HSV-2 encephalitis.
  • To explore the contribution of DWI to the diagnosis and understanding of lesion distribution in this condition.

Main Methods:

  • Retrospective review of clinical, laboratory, and imaging findings in 12 patients with proven neonatal HSV-2 encephalitis.
  • Analysis of 24 CT and 22 MRI studies, including DWI, with a mean follow-up of 38 months.
  • Evaluation of brain involvement patterns and lesion distribution.

Main Results:

  • Neonatal HSV-2 encephalitis presented with multifocal or localized brain involvement, affecting deep gray matter in 57% and showing hemorrhage in over half of patients.
  • CT and conventional MRI were often normal or showed mild abnormalities early in the disease course.
  • DWI detected lesions initially in 20% of patients and showed more extensive disease in 50% of additional patients; watershed ischemia was observed in 40%.

Conclusions:

  • Neonatal HSV-2 encephalitis exhibits a variable imaging appearance.
  • Diffusion-weighted MRI is an essential tool for evaluating neonatal HSV-2 encephalitis, revealing findings not seen on conventional MRI.
  • Watershed ischemia remote from primary herpetic lesions can be a feature of this disease.
Abstract

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