Atypical manifestations of herpes simplex encephalitis

The diagnosis of herpes simplex encephalitis is readily considered in patients with focal findings on neurologic and radiologic examinations. In the two patients we have described, the diagnosis was delayed because clinical findings were attributed to other medical conditions, and radiologic studies were nondiagnostic. A high index of suspicion and repeated neuroradiologic tests are recommended in patients with unexplained encephalitis.