title: MRI deterioration in herpes simplex encephalitis despite clinical recovery.
abstract: OBJECTIVE
  Herpes simplex virus type 1 is a sporadic cause of viral encephalitis. Relapse of encephalitis occurs in up to 10% of patients, manifested by recurrent symptoms, clinical and MRI findings, and the presence of herpes simplex virus type 1 DNA in the cerebrospinal fluid (CSF).
  
  
  METHODS
  We describe the clinical features, MRI findings and outcome in 2 patients with herpes simplex encephalitis during the acute phase and 6 months after the onset of encephalitis.
  
  
  RESULTS
  Both patients had a good response to treatment and an excellent recovery. Despite clinical recovery, in a 6-month follow-up MRI lesions consistent with recurrence were disclosed, without any clinical findings or CSF abnormalities.
  
  
  CONCLUSIONS
  The mechanism underlying this MRI deterioration is unclear and an immune-mediated mechanism may be involved. Thus, MRI deterioration after herpes simplex encephalitis should be interpreted with caution and it does not always represent a relapse, especially when the imaging studies do not correlate with the clinical and CSF findings.
authors: Departments of Neurology, University of Ioannina, Greece. me01415@cc.uoi.gr
authors: Sofia
authors: S
authors: Markoula
authors: Sotirios
authors: S
authors: Giannopoulos
authors: Sigliti-Henrietta
authors: SH
authors: Pelidou
authors: Maria
authors: M
authors: Argyropoulou
authors: Georgios
authors: G
authors: Lagos
authors: Athanassios P
authors: AP
authors: Kyritsis
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000821:virology*; D002540:Cerebral Cortex / Q000473:pathology; D002908:Chronic Disease / Q000188:drug therapy; D018450:Disease Progression; D020803:Encephalitis, Herpes Simplex / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006179:Gyrus Cinguli / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D020127:Recovery of Function / Q000276:immunology; D012008:Recurrence; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000998:Antiviral Agents; D000212:Acyclovir