Exploring the psychiatric spectrum of herpes simplex virus encephalitis

Area of Science:

• Neurology
• Infectious Diseases
• Psychiatry

Background:

• Herpes simplex encephalitis (HSE) classically presents with neurological symptoms.
• Atypical HSE presentations with psychiatric features can mimic primary psychiatric disorders.
• Delayed diagnosis of HSE can lead to severe neurological sequelae or death.

Purpose of the Study:

• To highlight the importance of considering HSE in patients with acute psychiatric symptoms.
• To describe the diagnostic challenges and successful management of HSE with atypical presentations.
• To emphasize the need for early intervention in HSE to improve patient outcomes.

Main Methods:

• Case series analysis of three patients with HSE presenting with psychiatric symptoms.
• Review of clinical presentations, diagnostic workup (CSF analysis, MRI), and treatment outcomes.
• Correlation of psychiatric manifestations with neuroimaging and laboratory findings.

Main Results:

• All three patients initially presented with prominent psychiatric symptoms (psychosis, mood disturbances) and lacked classic neurological signs.
• Cerebrospinal fluid analysis and MRI confirmed Herpes simplex virus encephalitis in all cases.
• Early initiation of antiviral therapy resulted in rapid clinical improvement and recovery in all patients.

Conclusions:

• Herpes simplex encephalitis should be considered in the differential diagnosis of acute psychiatric presentations.
• Atypical presentations of HSE underscore the need for a broad diagnostic approach.
• Timely diagnosis and antiviral treatment are critical for favorable outcomes in HSE, irrespective of initial symptoms.