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Herpes simplex encephalitis with thalamic, brainstem and cerebellar involvement.

Meenal Garg1, Shilpa Kulkarni1, Anaita Udwadia Hegde1

  • 1Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital for Children, Mumbai, India.

The Neuroradiology Journal
|June 20, 2017
PubMed
Summary

Herpes simplex virus encephalitis can present atypically, affecting the brainstem, cerebellum, and thalami. Early diagnosis is crucial for treatment, even with unusual imaging findings.

Keywords:
Herpes simplexJapanese encephalitisherpes simplex encephalitismagnetic resonance imagingthalamic involvement

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Neuroimaging

Background:

  • Herpes simplex virus encephalitis is a frequent, treatable cause of acute encephalitis across all age groups.
  • Typical radiological findings, like temporal lobe involvement, aid diagnosis.
  • Polymerase chain reaction (PCR) for herpes simplex virus has broadened understanding of its clinical and imaging spectrum.

Observation:

  • A young patient presented with a movement disorder.
  • Magnetic resonance imaging (MRI) revealed predominant involvement of the thalami, brainstem, and cerebellum.
  • This atypical presentation was diagnosed as herpes simplex virus encephalitis.

Findings:

  • Herpes simplex virus encephalitis can manifest with unusual patterns of brain involvement beyond the typical temporal lobes.
  • Movement disorders can be a presenting symptom.
  • Distinguishing from other encephalitides like Japanese encephalitis can be challenging in endemic regions.

Implications:

  • Expanded diagnostic criteria for herpes simplex virus encephalitis are needed to include atypical presentations.
  • Advanced neuroimaging and molecular diagnostics like PCR are vital for accurate diagnosis.
  • Consideration of herpes simplex virus encephalitis in cases of unexplained encephalitis with movement disorders and atypical MRI findings is essential, especially in endemic areas.