Optic chiasm involvement secondary to herpetic encephalitis. A case report

Area of Science:

• Neurology
• Infectious Diseases
• Neuroimaging

Background:

• Herpes simplex virus (HSV) encephalitis is a common and severe central nervous system (CNS) infection in adults.
• Early diagnosis and treatment are critical for improving patient outcomes.
• Clinical presentation can be varied, posing diagnostic challenges.

Purpose of the Study:

• To report a case of HSV encephalitis in an elderly patient with initial non-specific symptoms and delayed MRI findings.
• To highlight the importance of clinical suspicion and timely diagnostic confirmation.

Main Methods:

• Case report of a 70-year-old male patient.
• Clinical evaluation including visual disturbances, fever, seizures, and coma.
• Serial Magnetic Resonance Imaging (MRI) of the brain.
• Cerebrospinal fluid (CSF) analysis for HSV DNA detection.
• Treatment with intravenous acyclovir.

Main Results:

• Initial MRI showed no abnormalities; subsequent MRI revealed characteristic patterns of HSV encephalitis.
• CSF analysis confirmed the presence of herpes simplex virus DNA.
• The patient received intravenous acyclovir therapy.
• A third MRI demonstrated progression of typical HSV encephalitis findings and optic chiasm involvement.

Conclusions:

• HSV encephalitis can present with delayed or subtle initial neuroimaging findings.
• Clinical suspicion, supported by CSF PCR, is vital for early diagnosis.
• Aggressive antiviral therapy with acyclovir is essential for managing HSE.