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Encephalitis l: Introduction

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...

Encephalitis ll: Pathophysiology

Encephalitis ll: Pathophysiology

Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...

Arboviral Encephalitis

Arboviral Encephalitis

Arboviral encephalitis refers to brain inflammation caused by arthropod-borne viruses, particularly those transmitted through mosquito vectors. Among these, West Nile virus (WNV), a member of the Flaviviridae family, is a significant public health concern. WNV is an enveloped, positive-sense, single-stranded RNA virus. Human infection typically begins when an infected mosquito introduces the virus into the dermis during feeding. The primary transmission cycle involves birds as amplifying hosts...

Viral Meningitis

Viral Meningitis

Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...

Cytomegalovirus Disease

Cytomegalovirus Disease

Cytomegalovirus (CMV) disease is caused by human cytomegalovirus, a double-stranded DNA virus of the Herpesviridae family. While primary CMV infection is often asymptomatic in immunocompetent individuals, the virus can cause severe disease in neonates and immunocompromised patients. CMV is the most common cause of congenital viral infection in the United States, and a major pathogen in solid organ and hematopoietic stem cell transplant recipients.CMV is transmitted via bodily fluids, sexual...

Bacterial Meningitis II: Pathophysiology

Bacterial Meningitis II: Pathophysiology

Bacterial meningitis typically begins when pathogens such as Neisseria meningitidis and Streptococcus pneumoniae colonize the nasopharynx and invade the bloodstream. This process is facilitated by bacterial virulence factors, such as polysaccharide capsules, which resist phagocytosis and complement-mediated killing. Less commonly, bacteria reach the central nervous system via contiguous spread from infections like otitis media or sinusitis, through congenital or acquired dural defects, or...

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[Herpes Simplex Encephalitis].

Akihiko Morita¹

¹Department of Internal Medicine, Morita Hospital.

Brain and Nerve = Shinkei Kenkyu No Shinpo

|May 19, 2026

Summary

Herpes simplex encephalitis (HSE) is a severe brain infection. Early diagnosis and treatment with antiviral drugs like aciclovir (ACV) are crucial, with options for resistant cases or post-HSE autoimmune encephalitis.

Area of Science:

Neurology
Infectious Diseases
Immunology

Background:

Herpes simplex encephalitis (HSE) is the leading cause of sporadic viral encephalitis, carrying significant mortality and morbidity.
No specific clinical signs definitively diagnose HSE, necessitating laboratory confirmation.
Neurological relapses or worsening deficits affect nearly 30% of patients post-initial HSE episode.

Purpose of the Study:

To outline diagnostic and treatment strategies for Herpes Simplex Encephalitis (HSE).
To differentiate between primary HSE and autoimmune encephalitis (AE) post-HSE.
To describe management approaches for both aciclovir-resistant HSE and AE post-HSE.

Main Methods:

Diagnosis of HSE relies on herpes simplex virus (HSV) DNA polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF).

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Treatment involves intravenous aciclovir (ACV), with foscarnet considered for ACV-resistant cases.

Post-HSE autoimmune encephalitis (AE) is diagnosed by testing for neuronal antibodies (e.g., anti-NMDAR) in serum or CSF.

Main Results:

Optimal intravenous ACV treatment improves outcomes for HSE.
Negative HSV PCR in CSF prompts consideration of AE post-HSE.
AE post-HSE presents with distinct symptoms in children (choreoathetosis, seizures) and adults (altered consciousness, NMDAR-like symptoms).

Conclusions:

Prompt diagnosis and treatment of HSE with ACV are critical.
Management of HSE requires consideration of ACV resistance and potential secondary autoimmune processes.
AE post-HSE typically responds to immunotherapy, with escalation options available for refractory cases.