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[Clinico-pathologic case of slowly progressive herpes simplex encephalitis without temporal necrosis]
F Dubas1, I Pénisson-Besnier, A Pouplard-Barthelaix
1Service de Neurologie A, INSERM U.298, CHU Angers.
Revue Neurologique
|January 1, 1989
Summary
Herpes simplex encephalitis (HSE) can present atypically with prolonged symptoms like memory loss, without fever or seizures. This rare presentation suggests HSE should be considered in subacute encephalopathy diagnoses.
Area of Science:
- Neurology
- Virology
- Pathology
Background:
- Herpes simplex encephalitis (HSE) is a severe neurological condition.
- Typical HSE presentations often include fever, seizures, and rapid neurological decline.
Observation:
- A case of HSE is presented with atypical, prolonged symptoms including short-term memory deficits and irritability over three months.
- The patient did not exhibit fever or seizures, and cerebrospinal fluid (CSF) analysis was normal.
- Cranial computed tomography (CT) revealed a small low-density area in the right posterior orbito-frontal region.
Findings:
- Post-mortem examination showed necrosis predominantly in the posterior orbito-frontal areas, with relative sparing of the temporal cortex.
- Diagnostic confirmation included Cowdry type A inclusions, herpes virus-like particles, and positive immunofluorescence with HSV1 monoclonal antibodies.
- These findings confirmed the diagnosis of herpes simplex encephalitis.
Implications:
- Atypical, long-duration HSE cases are infrequently reported.
- This case highlights the importance of considering HSE in the differential diagnosis of subacute encephalopathy, even without typical symptoms.
- Recognizing these variations is crucial for timely diagnosis and management of HSE.