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[Herpes simplex brainstem encephalitis presenting high intensity area on MRI--a case report].

Y Matsumura1, K Matsubayashi, Y Yonezawa

  • 1Department of Medicine & Geriatrics, Kochi Medical School.

Rinsho Shinkeigaku = Clinical Neurology
|August 1, 1990
PubMed
Summary

This case report details herpes simplex virus (HSV) encephalitis affecting the brainstem, identified by MRI. Prompt treatment with aciclovir and steroids led to symptom improvement, highlighting a rare presentation of HSV encephalitis.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Herpes simplex virus (HSV) encephalitis is a severe neurological condition.
  • Brainstem involvement is a rare manifestation of HSV encephalitis.
  • Distinguishing HSV encephalitis from other neurological disorders like neuro-Behçet disease can be challenging.

Observation:

  • A 44-year-old woman presented with recurrent oral aphthous ulcerations, fever, and right hemiparesis.
  • Neurological examination revealed consciousness disturbance, neck stiffness, dysarthria, hemiparesis, sensory deficits, and truncal ataxia.
  • Cerebrospinal fluid (CSF) analysis showed pleocytosis, but CSF cultures were negative.
  • Brain MRI revealed a high-intensity area in the pons on T2-weighted images.
  • High positive titers of anti-herpes simplex virus (HSV) type I antibodies were detected in both serum and CSF.

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Findings:

  • The patient was diagnosed with HSV brainstem encephalitis based on clinical presentation, MRI findings, and serological evidence.
  • The high-intensity area in the pons on MRI, a previously unreported finding in HSV encephalitis, gradually reduced with treatment.
  • Treatment with aciclovir and adrenal corticosteroids resulted in gradual neurological symptom improvement.

Implications:

  • This case highlights a unique presentation of HSV encephalitis involving the brainstem with specific MRI findings.
  • Early diagnosis and treatment are crucial for improving outcomes in HSV encephalitis.
  • The case underscores the importance of considering HSV encephalitis in patients with unexplained neurological symptoms, even with atypical presentations.