title: Serial proton MR spectroscopy and diffusion imaging findings in HIV-related herpes simplex encephalitis.
abstract: We report the case of pathologically proved atypical herpes simplex encephalitis (HSE) in a 40-year-old male patient with AIDS who was followed up by MR imaging, which included diffusion-weighted imaging and proton MR spectroscopy ((1)H-MRS). MR revealed sparing of hippocampi and limbic cortices, necrosis of both cingulate gyri, and cerebellar involvement. Increased diffusivity and severe metabolic alterations were compatible with biopsy findings of necrotizing inflammation. Clinical recovery corresponded with partial metabolite and diffusion normalization and a myo-inositol increase that indicated evolving gliosis formation further corroborated by immunohistochemistry results. (1)H-MRS and diffusion-weighted imaging may both support the diagnosis of HSE in patients with AIDS and help in the follow-up of necrotizing inflammation.
authors: Max-Planck-Institute of Psychiatry, NMR Study Group, Munich, Germany.
authors: Philipp G
authors: PG
authors: Sämann
authors: Jürgen
authors: J
authors: Schlegel
authors: Georg
authors: G
authors: Müller
authors: Franz
authors: F
authors: Prantl
authors: Christoph
authors: C
authors: Emminger
authors: Dorothee P
authors: DP
authors: Auer
mesh_terms: D000328:Adult; D038524:Diffusion Magnetic Resonance Imaging; D020803:Encephalitis, Herpes Simplex / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007150:Immunohistochemistry; D007294:Inositol / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D009336:Necrosis; D011522:Protons
chemical_list: D011522:Protons; D007294:Inositol