title: Progression of MRI abnormalities in herpes simplex encephalitis despite clinical improvement: natural history or disease progression?
abstract: Herpes simplex virus encephalitis (HSVE) is associated with a high mortality rate and a high probability of neurological sequelae. Good results are obtained when HSVE is promptly diagnosed and treated with acyclovir. We present a 71-year-old woman with clinically diagnosed HSVE, confirmed by PCR detection of HSV-1 DNA in the cerebrospinal fluid. She was treated with acyclovir (30 mg/kg day) for two weeks. Clinical and neuropsychological assessments 6 months after admission were normal; however MRI at 2, 6 and 12 months showed progressive deterioration with extensive white matter and cortical damage. Imaging studies of a cohort of patients surviving PCR-confirmed HSVE are needed to determine whether this pattern is occasional or a frequent form of progression.
authors.affiliation: Neurological Clinic, Ospedale Maggiore della Carità, A. Avogadro University of Eastern Piedmont, Corso Mazzini 18, I-28100 Novara, Italy. paolagaviani@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Gaviani
authors.forename: M
authors.initials: M
authors.lastname: Leone
authors.forename: M
authors.initials: M
authors.lastname: Mula
authors.forename: P
authors.initials: P
authors.lastname: Naldi
authors.forename: E
authors.initials: E
authors.lastname: Macchiarulo
authors.forename: D
authors.initials: D
authors.lastname: Brustia
authors.forename: F
authors.initials: F
authors.lastname: Monaco
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology / Q000821:virology; D003071:Cognition; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D018450:Disease Progression; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology*; D005260:Female; D018259:Herpesvirus 1, Human / Q000302:isolation & purification* / Q000472:pathogenicity; D006801:Humans; D008279:Magnetic Resonance Imaging; D009410:Nerve Degeneration / Q000821:virology; D009483:Neuropsychological Tests
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir