Progression of MRI abnormalities in herpes simplex encephalitis despite clinical improvement: natural history or disease progression?
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.
Gaviani
P
P
Neurological Clinic, Ospedale Maggiore della Carità, A. Avogadro University of Eastern Piedmont, Corso Mazzini 18, I-28100 Novara, Italy. paolagaviani@hotmail.com
Leone
M
M
Mula
M
M
Naldi
P
P
Macchiarulo
E
E
Brustia
D
D
Monaco
F
F
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
D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir